Greater early postprandial suppression of endogenous glucose production and higher initial glucose disappearance is achieved with fast‐acting insulin aspart compared with insulin aspart

Autor: Ann Kathrine Hansen, Lars Erichsen, Stefanie Sach-Friedl, Hanne Haahr, Ananda Basu, Rita Basu, Thomas R. Pieber
Rok vydání: 2018
Předmět:
Blood Glucose
Male
endocrine system diseases
type 1 diabetes
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Type 2 diabetes
Fatty Acids
Nonesterified
0302 clinical medicine
Endocrinology
Medicine
030212 general & internal medicine
Carbon Isotopes
Cross-Over Studies
Middle Aged
Postprandial Period
Postprandial
Female
Original Article
type 2 diabetes
pharmacokinetics
medicine.drug
Adult
medicine.medical_specialty
Drug Compounding
glucose metabolism
030209 endocrinology & metabolism
Carbohydrate metabolism
Tritium
Insulin aspart
03 medical and health sciences
Double-Blind Method
Internal medicine
pharmacodynamics
Internal Medicine
Humans
Hypoglycemic Agents
Insulin Aspart
Type 1 diabetes
business.industry
Insulin
Gluconeogenesis
nutritional and metabolic diseases
Original Articles
Deuterium
medicine.disease
Crossover study
Diabetes Mellitus
Type 1
Hyperglycemia
insulin therapy
Pharmacodynamics
business
Follow-Up Studies
Zdroj: Diabetes, Obesity & Metabolism
ISSN: 1463-1326
1462-8902
DOI: 10.1111/dom.13270
Popis: AIM To investigate the mechanisms behind the lower postprandial glucose (PPG) concentrations achieved with fast-acting insulin aspart (faster aspart) than with insulin aspart (IAsp). MATERIALS AND METHODS In a randomized, double-blind, crossover trial, 41 people with type 1 diabetes received identical subcutaneous single faster aspart and IAsp doses (individualized for each participant), together with a standardized mixed meal (including 75 g carbohydrate labelled with [1-13 C] glucose). PPG turnover was determined by the triple-tracer meal method using continuous, variable [6-3 H] glucose and [6,6-2 H2 ] glucose infusion. RESULTS Insulin exposure within the first hour was 32% greater with faster aspart than with IAsp (treatment ratio faster aspart/IAsp 1.32 [95% confidence interval {CI} 1.18;1.48]; P < .001), leading to a 0.59-mmol/L non-significantly smaller PPG increment at 1 hour (ΔPG1h ; treatment difference faster aspart-IAsp -0.59 mmol/L [95% CI -1.19; 0.01]; P = .055). The trend towards reduced ΔPG1h with faster aspart was attributable to 12% greater suppression of endogenous glucose production (EGP; treatment ratio 1.12 [95% CI 1.01; 1.25]; P = .040) and 23% higher glucose disappearance (1.23 [95% CI 1.05; 1.45]; P = .012) with faster aspart than with IAsp during the first hour. Suppression of free fatty acid levels during the first hour was 36% greater for faster aspart than for IAsp (1.36 [95% CI 1.01;1.88]; P = .042). CONCLUSIONS The trend towards improved PPG control with faster aspart vs IAsp in this study was attributable to both greater early suppression of EGP and stimulation of glucose disappearance.
Databáze: OpenAIRE
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