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Meta-Analysis
. 2022 Nov:193:110144.
doi: 10.1016/j.diabres.2022.110144. Epub 2022 Nov 6.

Efficacy and safety of ultra-rapid insulin analogues in insulin pumps in patients with Type 1 Diabetes Mellitus: A systematic review and meta-analysis

Athina Stamati  1 , Thomas Karagiannis  2 , Apostolos Tsapas  2 , Athanasios Christoforidis  3
Affiliations
Meta-Analysis

Efficacy and safety of ultra-rapid insulin analogues in insulin pumps in patients with Type 1 Diabetes Mellitus: A systematic review and meta-analysis

Athina Stamati et al. Diabetes Res Clin Pract. 2022 Nov.

Abstract

Aims: To assess the efficacy and safety of ultra-rapid insulin analogues used with continuous subcutaneous insulin infusion systems (CSII) in adults with type 1 diabetes (T1DM).

Methods: We searched MEDLINE and Cochrane Library up to May 2022 for randomized controlled trials comparing ultra-rapid with rapid-acting insulin analogues (RAIAs) used with CSII. We performed random effects meta-analyses for % of 24-h time in range of 70-180 mg/dl (TIR), time in hypoglycaemia (<70 mg/dl) and hyperglycaemia (>180 mg/dl), 1- and 2-hour post-prandial glucose [PPG] increment after a meal test, HbA1c and average insulin dose at endpoint, unplanned infusion set changes and severe hypoglycaemia.

Results: Nine studies (1,156 participants) were included. Ultra-rapid insulins were superior to RAIAs on TIR (mean difference [MD] 1.1 %, 95 % CI 0.11-2.11), time spent in hypoglycaemia (MD -0.47 %, 95 % CI -0.63 to -30), and 1- and 2-hour PPG (MD -12.20 mg/dl, 95 % CI -19.85 to -4.54 and MD -17.61 mg/dl, 95 % CI -28.55 to -6.66, respectively). Ultra-rapid insulins increased odds of unplanned infusion set changes (odds ratio 1.60, 95 % CI 1.26-2.03).

Conclusion: Ultra-rapid acting insulins provided better PPG control compared to RAIAs but their use might result in more infusion set changes.

Keywords: FIAsp; Insulin pumps; Meta-analysis; Systematic review; Type 1 diabetes mellitus; URLi.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.T. has served on an advisory board for Novo Nordisk and Boehringer Ingelheim, and his university has received funding for educational and research support from Boehringer Ingelheim, Eli Lilly and Novo Nordisk, all outside this work. A.S., T.K. and A.C. declare that they have no relevant or material financial interests that relate to the research described in this paper.

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