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Villar-Taibo R, Galdón Sanz-Pastor A, Fernández-Rubio E, Barajas Galindo D, Simó Servat A, Ampudia-Blasco FJ. Are New Ultra-Rapid-Acting Insulins Associated with Improved Glycemic Control and Reduced Hypoglycemia in Comparison to Conventional Rapid-Acting Insulins for Individuals with Type 1 and Type 2 Diabetes? A Systematic Review and Meta-Analysis. Diabetes Technol Ther 2024; 26:575-586. [PMID: 38502158 DOI: 10.1089/dia.2023.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Introduction: This study aimed to compare efficacy and safety of ultra-rapid-acting insulin analogs (URAIs; faster aspart [FAsp], ultra-rapid lispro [URLi], and technosphere insulin [TI]) with rapid-acting insulin analogs (RAI) in individuals with type 1 (T1D) or type 2 diabetes (T2D). Methods: Searching for randomized control trial comparing the effects of URAI versus RAI that lasted at least 12 weeks, we initially selected 15 studies for analysis. Three studies involving TI were excluded due to a high degree of heterogeneity. The final meta-analysis included only 12 studies with either FAsp or URLi. Results: Mealtime URAI significantly reduced overall early 1 h postprandial glycemia in individuals with T1D (-20.230 mg/dL [95% confidence interval, 95% CI -24.040 to -16.421]; P < 0.001; I2 = 33.42%) and those with T2D (-9.138 mg/dL [95% CI -12.612 to -5.663]; P < 0.001; I2 = 0%). However, the significant reduction in 2 h postprandial glucose remained only in individuals with T1D (-17.620 mg/dL [95% CI -26.047 to -9.193]; P < 0.001; I2 = 65.88%). These benefits were lost when URAI was administered postmeal. At 24-26 weeks, there was no significant difference in HbA1c between groups, but at 52 weeks, a slight reduction in HbA1c with mealtime URAI was observed (-0.080% [95% CI -0.147 to -0.013]; P = 0.019; I2 = 0%). No difference in weight or the rate of severe or confirmed hypoglycemia was observed. Only individuals with T1D showed a small, but significant increase in early 1-h hypoglycemia with URAI (1.468 [95% CI 1.235 to 1.747]; P < 0.001; I2 = 0%). Conclusion: Mealtime URAI improves 1 and 2 h postprandial glycemic control compared to RAI without increasing hypoglycemia or weight gain.
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Affiliation(s)
- Rocío Villar-Taibo
- Endocrinology Department, University Hospital of Santiago de Compostela, Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela, Spain
| | - Alba Galdón Sanz-Pastor
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Medicine Department, Complutense University of Madrid, Madrid, Spain
| | - Elsa Fernández-Rubio
- Department of Endocrinology and Nutrition, Cruces University Hospital, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - David Barajas Galindo
- Section of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain
| | | | - Francisco Javier Ampudia-Blasco
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Research Foundation, Valencia, Spain
- CIBERDEM, Madrid, Spain
- Department of Medicine, Universitat de Valencia, Valencia, Spain
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Crabtree TS, Griffin TP, Yap YW, Narendran P, Gallen G, Furlong N, Cranston I, Chakera A, Philbey C, Karamat MA, Saraf S, Kamaruddin S, Gurnell E, Chapman A, Hussain S, Elliott J, Leelarathna L, Ryder RE, Hammond P, Lumb A, Choudhary P, Wilmot EG. Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study. Diabetes Care 2023; 46:1831-1838. [PMID: 37566697 PMCID: PMC10516256 DOI: 10.2337/dc23-0635] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. RESEARCH DESIGN AND METHODS We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL. RESULTS In total, 570 HCL users were included (median age 40 [IQR 29-50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70-180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]). CONCLUSIONS Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.
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Affiliation(s)
- Thomas S.J. Crabtree
- Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K
| | - Tomás P. Griffin
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, U.K
- Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, U.K
| | - Yew W. Yap
- Department of Diabetes and Endocrinology, Aintree University Hospital, Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K
| | - Parth Narendran
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, Birmingham, U.K
- The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, U.K
| | | | - Niall Furlong
- Diabetes Center, St. Helens Hospital, St. Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, U.K
| | - Iain Cranston
- Academic Department of Endocrinology and Diabetes Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth, U.K
| | - Ali Chakera
- Department of Diabetes and Endocrinology, University Hospitals Sussex, Brighton, U.K
- Brighton and Sussex Medical School, Brighton, U.K
| | - Chris Philbey
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, U.K
| | - Muhammad Ali Karamat
- Department of Diabetes and Endocrinology, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Sanjay Saraf
- Department of Diabetes and Endocrinology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, U.K
| | - Shafie Kamaruddin
- Department of Diabetes and Endocrinology, County Durham and Darlington Foundation Trust, Darlington, U.K
| | - Eleanor Gurnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Trust, Cambridge, U.K
| | - Alyson Chapman
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, U.K
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King’s College London, London, U.K
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
| | - Jackie Elliott
- Diabetes and Endocrine Center, Sheffield Teaching Hospitals, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, U.K
| | - Lalantha Leelarathna
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, U.K
| | - Robert E.J. Ryder
- Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K
| | - Peter Hammond
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, U.K
| | - Alistair Lumb
- Oxford Center for Diabetes Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford, U.K
- National Institute for Health and Care Research, Oxford Biomedical Research Center, Oxford, U.K
| | - Pratik Choudhary
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, U.K
- Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, U.K
| | - Emma G. Wilmot
- Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K
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Fadini GP, Boscari F, Falaguasta D, Ferretto S, Maran A, Avogaro A, Bruttomesso D. Glycemic control after switching to faster aspart in adults with type 1 diabetes. J Endocrinol Invest 2022; 45:1181-1188. [PMID: 35103951 PMCID: PMC9098588 DOI: 10.1007/s40618-022-01745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
AIMS Post-prandial hyperglycemia remains an unmet need in the management of type 1 diabetes (T1D). In randomized trials, faster insulin aspart (FIA) showed modest but significant reductions of glycemic spikes after meals. Whether such benefit is evident in routine clinical practice is unclear. METHODS We analyzed data of patients with T1D at the time they switched from a prior bolus insulin to FIA and at the first available follow-up. The primary endpoint was the change in the time spent in hyperglycemia > 250 mg/dl during daytime from flash glucose monitoring (FGM). Secondary outcomes included the change in HbA1c, body weight, insulin dose and other FGM metrics. RESULTS We included 117 patients with T1D on multiple daily injections who switched to FIA, 57 of whom had data from FGM. Patients were 41-year-old, 51.3% men, with 19.3 years diabetes duration and a baseline HbA1c of 7.7% (60 mmol/mol). Mean observation time was 4.3 months. After switching to FIA, HbA1c declined by 0.1% (1 mmol/mol) only in patients with baseline HbA1c > 7.0% (53 mmol/mol). Time spent in hyperglycemia > 250 mg/dl during daytime was significantly reduced from 14.8 to 11.9% (p = 0.006). Time in range improved from 48.3 to 51.0% (p = 0.028). Results were consistent across various patient characteristics. CONCLUSIONS Under routine care, patients with T1D who switched to FIA experienced a reduction in the time spent in hyperglycemia > 250 mg/dl during daytime and an increase in time in range. These improvements may be due to better control of post-prandial hyperglycemia, as observed in trials.
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Affiliation(s)
- G P Fadini
- Department of Medicine - DIMED, Division of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy.
| | - F Boscari
- Department of Medicine - DIMED, Division of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy
| | - D Falaguasta
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy
| | - S Ferretto
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy
| | - A Maran
- Department of Medicine - DIMED, Division of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy
| | - A Avogaro
- Department of Medicine - DIMED, Division of Metabolic Disease, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy
| | - D Bruttomesso
- Division of Metabolic Disease, University Hospital of Padova, Padua, Italy
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Malecki MT, Cao D, Liu R, Hardy T, Bode B, Bergenstal RM, Bue-Valleskey J. Ultra-Rapid Lispro Improves Postprandial Glucose Control and Time in Range in Type 1 Diabetes Compared to Lispro: PRONTO-T1D Continuous Glucose Monitoring Substudy. Diabetes Technol Ther 2020; 22:853-860. [PMID: 32453647 PMCID: PMC7698997 DOI: 10.1089/dia.2020.0129] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: This study evaluated glucose control by continuous glucose monitoring (CGM) during treatment with ultra-rapid lispro (URLi) or lispro used in combination with insulin glargine or degludec in adults with type 1 diabetes in a substudy of the PRONTO-T1D study. Methods: Ambulatory glucose profiles were evaluated in 269 patients from PRONTO-T1D assigned to double-blind URLi (n = 97) or lispro (n = 99) given 0-2 min before the start of the meal (mealtime), or open-label URLi (n = 73) given 20 min after the meal (postmeal URLi). Blinded CGM was used for up to 14 days before baseline and the 26-week primary endpoint. The primary objective was to compare mealtime URLi and lispro with respect to incremental area under the serum glucose concentration versus time curve from 0 to 2 h (iAUC0-2h) after breakfast. Results: Mealtime URLi was superior in reducing the iAUC0-2h when compared to lispro for breakfast (least squares mean [LSM] difference -28.1 mg·h/L, P = 0.048) and for all meals combined. iAUC0-3h and iAUC0-4h were also reduced. Postmeal URLi resulted in similar postprandial glucose (PPG) control to mealtime lispro, but less optimal PPG control compared to mealtime URLi. Mealtime URLi increased daytime time in range (71-180 mg/dL [3.9-10.0 mmo/L]) (LSM difference = +43.6 min, P = 0.020) and decreased nighttime time in hypoglycemia (LSM difference ≤70 mg/dL [3.9 mmol/L] = -11.5 min, P = 0.009) compared to mealtime lispro. Conclusions: Results of this CGM substudy support the improved PPG control seen with mealtime URLi in the PRONTO-T1D study and show that mealtime URLi resulted in improved daytime time in target range.
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Affiliation(s)
- Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Dachuang Cao
- DC and RL Clinical Design, Delivery, and Analytics, TH and JB-V Connected Care and Insulins—Medical Development, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Rong Liu
- DC and RL Clinical Design, Delivery, and Analytics, TH and JB-V Connected Care and Insulins—Medical Development, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Thomas Hardy
- DC and RL Clinical Design, Delivery, and Analytics, TH and JB-V Connected Care and Insulins—Medical Development, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Bruce Bode
- Endocrinologist and Partner, Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Richard M. Bergenstal
- Endocrinologist and Executive Director, International Diabetes Center, Minneapolis, Minnesota, USA
| | - Juliana Bue-Valleskey
- DC and RL Clinical Design, Delivery, and Analytics, TH and JB-V Connected Care and Insulins—Medical Development, Eli Lilly and Company, Indianapolis, Indiana, USA
- Address correspondence to: Juliana Bue-Valleskey, MS, Connected Care and Insulins—Medical Development, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
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