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Randomized Controlled Trial
. 2025 Apr;27(4):2147-2153.
doi: 10.1111/dom.16211. Epub 2025 Jan 27.

Postprandial time in tight range with faster insulin aspart compared with standard insulin aspart in youth with type 1 diabetes using automated insulin delivery

Klemen Dovč  1   2 , Charles Spanbauer  3 , Eleonora Chiarle  4 , Natasa Bratina  1   2 , Elke Fröhlich-Reiterer  5 , Nejka Potočnik  6 , Dessi P Zaharieva  7 , Tim Hropot  1   2 , Maria Fritsch  5 , Peter Calhoun  3 , Tadej Battelino  1   2
Affiliations
Randomized Controlled Trial

Postprandial time in tight range with faster insulin aspart compared with standard insulin aspart in youth with type 1 diabetes using automated insulin delivery

Klemen Dovč et al. Diabetes Obes Metab. 2025 Apr.

Abstract

Aims: The aim of this study was to assess postprandial glycaemic outcomes using automated insulin delivery with faster acting insulin aspart (FIA) or standard insulin aspart (SIA) over 4 weeks in youth (aged 10-18 years) with type 1 diabetes.

Materials and methods: We undertook a secondary analysis of postprandial glycaemic outcomes from a double-blind, randomised, crossover study comparing FIA to SIA using an investigational version of MiniMed™ 780G. Endpoints included postprandial time in tight range (70-140 mg/dL; TITR), postprandial glucose excursions and peak glucose, and incremental area under curve (iAUC).

Results: The mean ± SD age of 30 included participants was 15.0 ± 1.7 years, 47% were male, mean HbA1c was 7.5% ± 0.9% (58 ± 9.8 mmol/mol) and the number of meals per day per participant was 3.2 ± 1.2 meals. Overall, the postprandial outcomes were improved with FIA compared with SIA. Mean glucose at the start of the meal was 151 mg/dL in the FIA group and reached a peak glucose of 194 mg/dL, compared with starting level of 151 mg/dL in the SIA group and a peak of 198 mg/dL (difference in excursion: -3.8 mg/dL; 95% confidence interval -5.8 to -1.7; p <0.001). FIA group also had a 1.9% increase in mean TITR (p = 0.02) and a 2.0-mg/dL decrease in mean iAUC (p = 0.003). Differences in outcomes were the most noticeable for breakfast, meals with a larger amount of carbohydrates (>45 g) and participants with lower insulin-to-carbohydrate ratios.

Conclusions: Faster insulin formulation with AID improved postprandial glycaemic outcomes and could be a useful therapeutical option in youth with type 1 diabetes that have challenges achieving glycaemic targets.

Keywords: continuous glucose monitoring (CGM); glycaemic control; insulin therapy; type 1 diabetes.

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Conflict of interest statement

KD has received honoraria for speaking engagements from Abbott, Eli Lilly, Medtronic, Novo Nordisk and Pfizer and is on an advisory board for Medtronic and Novo Nordisk. EFR has received honoraria for speaking engagements and advisory boards from Medtronic, Eli Lilly, Sanofi, Merck and Sandoz. DPZ has received honoraria for speaking engagements from Ascensia Diabetes, Insulet Canada, Dexcom Canada and Medtronic and is on an advisory board for Dexcom and has received an ISPAD‐JDRF Research Fellowship and research support from Insulet and the Leona M, and Harry B. Helmsley Charitable Trust. TB received honoraria for participating on the speaker's bureaux of Eli Lilly, Novo Nordisk, Medtronic, Abbott, Sanofi, Dexcom, Aventis, Astra Zeneca and Roche. TB's institution received research grant support from Abbott, Medtronic, Novo Nordisk, Sanofi, Novartis, Sandoz, Zealand Pharma, Slovenian Research Agency, the National Institutes of Health and the European Union. Other authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Mean glucose by hour after the meal averaged over all participants. Mean glucose values averaged over the participants by period every 5 min after the meal. The bands represent the 95% confidence interval of mean glucose. FIA, faster acting insulin aspart; SIA, standard insulin aspart.
FIGURE 2
FIGURE 2
Outcomes by treatment overall and by meal type. Boxplots of (A) % time in 70–140 and (B) excursion (mg/dL) for each treatment period overall and by meal type. The dot inside the box represents the mean, and the line inside the box represents the median. The bottom and top of the box represent the first and third quartiles respectively, while the bottom and top ends of the whiskers represent the 10th and 90th percentiles respectively. TITR, time in tight range.
See this image and copyright information in PMC

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