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. 2023 Sep;14(9):1563-1575.
doi: 10.1007/s13300-023-01444-y. Epub 2023 Jul 14.

Fast-Acting Insulin Aspart in Patients with Type 1 Diabetes in Real-World Clinical Practice: A Noninterventional, Retrospective Chart and Database Study

Marcus Lind  1   2 , Sergiu-Bogdan Catrina  3   4 , Neda R Ekberg  3   4 , Sofia Gerward  5 , Tariq Halasa  6 , Jarl Hellman  7 , Detlef Hess  8 , Magnus Löndahl  9 , Veronica Qvist  10 , Jan Bolinder  11
Affiliations

Fast-Acting Insulin Aspart in Patients with Type 1 Diabetes in Real-World Clinical Practice: A Noninterventional, Retrospective Chart and Database Study

Marcus Lind et al. Diabetes Ther. 2023 Sep.

Abstract

Introduction: This study utilized continuous glucose monitoring data to analyze the effects of switching to treatment with fast-acting insulin aspart (faster aspart) in adults with type 1 diabetes (T1D) in clinical practice.

Methods: A noninterventional database review was conducted in Sweden among adults with T1D using multiple daily injection (MDI) regimens who had switched to treatment with faster aspart as part of basal-bolus treatment. Glycemic data were retrospectively collected during the 26 weeks before switching (baseline) and up to 32 weeks after switching (follow-up) to assess changes in time in glycemic range (TIR; 70-180 mg/dL), mean sensor glucose, glycated hemoglobin (HbA1c) levels, coefficient of variation, time in hyperglycemia (level 1, > 180 to ≤ 250 mg/dL; level 2, > 250 mg/dL), and time in hypoglycemia (level 1, ≥ 54 to < 70 mg/dL; level 2, < 54 mg/dL) (ClinicalTrials.gov Identifier NCT03895515).

Results: Overall, 178 participants were included in the study cohort. The analysis population included 82 individuals (mean age 48.5 years) with adequate glucose sensor data. From baseline to follow-up, statistically significant improvements were reported for TIR (mean increase 3.3%-points [approximately 48 min/day]; p = 0.006) with clinically relevant improvement (≥ 5%) in 43% of participants. Statistically significant improvements from baseline were observed for mean sensor glucose levels, HbA1c levels, and time in hyperglycemia (levels 1 and 2), with no statistically significant changes in time spent in hypoglycemia.

Conclusions: Switching to faster aspart was associated with improvements in glycemic control without increasing hypoglycemia in adults with T1D using MDI in this real-world setting.

Keywords: Diabetes mellitus, type 1; Glycemic control; Insulin, short-acting; Time in range.

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Conflict of interest statement

Marcus Lind has received honoraria or has been a consultant for AstraZeneca, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk, and received research grants from Eli Lilly and Novo Nordisk. Sergiu Bogdan Catrina has no conflicts of interest to disclose. Neda Rajamand Ekberg has, on behalf of her employer, received gratuities for lecturing and participating in scientific boards for Novo Nordisk. Sofia Gerward and Tariq Halasa are employees of Novo Nordisk A/S. Jarl Hellman has served on advisory boards or lectured for Abbot, AstraZeneca, Bayer, Boehringer Ingelheim, Lilly, MSD, Nordic Infucare, Novo Nordisk, Rubin Medical, and Sanofi. Detlef Hess has stock or stock options for AstraZeneca. Magnus Löndahl has received honoraria for consulting and/or lecture fees and/or unrestricted research grants from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, and Sanofi. Veronica Qvist has no conflicts of interest to disclose. Jan Bolinder has received honoraria for consulting and/or lecture fees from Abbott Diabetes Care, MannKind Corporation, Nanexa, Nordic InfuCare, Novo Nordisk, and Sanofi.

Figures

Fig. 1
Fig. 1
Study timeline. The index date was defined as the date of the first faster aspart prescription. The pre-index period was defined as 182 days (26 weeks) up to and including the index date, and the post-index period was defined as 182–224 days (26–32 weeks) after the index date. Sensor glucose measurements were analyzed from day 141 (start of week 21) to day 224 (end of week 32). HbA1c measurements were analyzed from day 85 (start of week 13) to day 224 (end of week 32), according to data availability and by considering the measurement closest to day 182 (end of week 26) per patient. For the analysis, only one 2-week period with sufficient glucose data quality (≥ 70% of available CGM measurements) was included per participant for each of the pre-index baseline and post-index follow-up periods. Faster aspart fast-acting insulin aspart, HbA1c glycated hemoglobin
Fig. 2
Fig. 2
Participant recruitment in the study. A 2-week period with sufficient glucose data quality (≥ 70% of available sensor glucose measurements) was required per participant for each of the pre-index baseline and post-index follow-up periods. Faster aspart fast-acting insulin aspart, isCGM intermittently scanned continuous glucose monitoring, rtCGM real-time continuous glucose monitoring
Fig. 3
Fig. 3
Changes in key glycemic parameters. A Mean proportion of time within each glucose range in the sensor glucose analysis set. B Change in time within each glucose range per day from baseline to follow-up in the sensor glucose analysis set. CI confidence interval
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