- Fast-acting insulin aspart (faster aspart) plus insulin degludec was associated with an earlier glucose-lowering effect than insulin aspart (IAsp) in adults with long-standing advanced type 2 diabetes (T2D) inadequately controlled with a basal-bolus approach.
Why this matters
- Insulin and rapid-acting insulin analogs result in slower glucose-lowering effects than pancreatic insulin.
- Patients with long-standing T2D (≥20 years) were randomly assigned to either mealtime faster aspart (n=546) or IAsp (n=545), both with insulin degludec, for a total of 16 weeks.
- Participants consumed a liquid meal consisting of 78 grams of carbohydrate to quantify postprandial glucose change.
- Primary endpoint: change in HbA1c from baseline to 16 weeks (noninferiority).
- Funding: Novo Nordisk.
- Study confirmed noninferiority in terms of the primary endpoint for faster aspart compared with IAsp (estimated treatment difference [ETD], −0.04% [95% CI, −0.11 to 0.03]; −0.39 mmol/mol [95% CI, −1.15 to 0.37]).
- Faster aspart was associated with a greater change in 1-hour postprandial glucose vs IAsp (ETD, −0.40 mmol/L [95% CI, −0.66 to −0.14]; −7.23 mg/dL [95% CI, −11.92 to −2.55]).
- Use of faster aspart was associated with a lower overall rate of treatment-emergent severe or blood glucose-confirmed hypoglycemia compared with IAsp (estimated treatment ratio, 0.81 [95% CI, 0.68-0.97]).
- Short duration of follow-up.