Postprandial Glucose Excursions with Ultra-Rapid Insulin Analogs in Hybrid Closed-Loop Therapy for Adults with Type 1 Diabetes

• Published in: Diabetes technology & therapeutics Vol. 26; no. 7; p. 449
• Main Authors: Haliloglu, Belma, Boughton, Charlotte K, Lakshman, Rama, Ware, Julia, Nwokolo, Munachiso, Thabit, Hood, Mader, Julia K, Bally, Lia, Leelarathna, Lalantha, Wilinska, Malgorzata E, Allen, Janet M, Hartnell, Sara, Evans, Mark L, Hovorka, Roman
• Format: Journal Article
• Language: English
• Published: United States 01.07.2024
• Subjects: Adult; Algorithms; Blood Glucose - analysis; Cross-Over Studies; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Double-Blind Method; Female; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; Insulin Aspart - administration & dosage; Insulin Aspart - therapeutic use; Insulin Infusion Systems; Insulin Lispro - administration & dosage; Insulin Lispro - therapeutic use; Male; Middle Aged; Postprandial Period; Postprandial glucose excursion; Ultra-rapid lispro; Hybrid closed loop; Fast-acting insulin aspart
• ISSN: 1557-8593
• DOI: 10.1089/dia.2023.0509

To evaluate postprandial glucose control when applying (1) faster-acting insulin aspart (Fiasp) compared to insulin aspart and (2) ultra-rapid insulin lispro (Lyumjev) compared to insulin lispro using the CamAPS FX hybrid closed-loop algorithm. We undertook a secondary analysis of postprandial glucose excursions from two double-blind, randomized, crossover hybrid closed-loop studies contrasting Fiasp to standard insulin aspart, and Lyumjev to standard insulin lispro. Endpoints included incremental area under curve (iAUC)-2h, iAUC-4h, 4 h postprandial time in target range, time above range, and time below range. It was approved by independent research ethics committees. Two trials with 8 weeks of data from 51 adults with type 1 diabetes were analyzed and 7137 eligible meals were included. During Lyumjev compared with insulin lispro, iAUC-2h and iAUC-4h were significantly decreased following breakfast (mean difference 92 mmol/L per 2 h (95% confidence interval [CI]: 56 to 127);  < 0.001 and 151 mmol/L per 4 h (95% CI: 74 to 229);  < 0.001, respectively) and the evening meal (  < 0.001 and  = 0.011, respectively). Mean time in target range (3.9-10.0 mmol/L) for 4 h postprandially significantly increased during Lyumjev with a mean difference of 6.7 percentage points (95% CI: 3.3 to 10) and 5.7 percentage points (95% CI: 1.4 to 9.9) for breakfast and evening meal, respectively. In contrast, there were no significant differences in iAUC-2h, iAUC-4h, and the other measures of postprandial glucose control between insulin aspart and Fiasp during breakfast, lunch, and evening meal (  > 0.05). The use of Lyumjev with CamAPS FX closed-loop system improved postprandial glucose excursions compared with insulin lispro, while the use of Fiasp did not provide any advantage compared with insulin aspart. Clinical Trial Registration numbers: NCT04055480, NCT05257460.