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Comparison between preprandial vs. postprandial insulin aspart in patients with type 1 diabetes on insulin pump and real‐time continuous glucose monitoring
Author(s) -
Thuillier Philippe,
Sonnet Emmanuel,
Alavi Zarrin,
Roudaut Nathalie,
Nowak Emmanuel,
Dion Angélina,
Kerlan Véronique
Publication year - 2018
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.3019
Subject(s) - postprandial , medicine , glycemic , insulin aspart , insulin , crossover study , area under the curve , insulin pump , bolus (digestion) , type 2 diabetes , regimen , type 1 diabetes , diabetes mellitus , endocrinology , meal , gastroenterology , placebo , alternative medicine , pathology
Background The objective was to compare glycemic control between preprandial and postprandial bolus administration (15 min before [PRE] or immediately after the meal [POST]) in patients with type 1 diabetes using insulin pump and real‐time continuous glucose monitoring. Methods Between September 2015 and February 2016, a single‐centre, open randomized, 2‐way crossover study of patients on bolus insulin aspart administration was conducted during two 14‐day periods and according to 2 administration regimen schedules (PRE/POST or POST/PRE). Inclusion criteria were as follows: patients with type 1 diabetes, ≥18 and ≤ 65 years old, treated with insulin aspart using a Medtronic® insulin pump and trained on functional insulin therapy. Patients were randomly assigned to either regimen schedule. At the beginning of each period, each patient was provided with a standardized high fat meal. Primary outcome was the area under the curve for interstitial glucose above 140 mg/dL per minute (AUC > 140 mg/dL/min) during each period. Secondary outcomes were time spent in hypo/eu/hyperglycemia, glycemic variability indices, and AUC during 4 hours after high fat meal calculated with continuous glucose monitoring data. Results Twenty‐two patients were included. Mean AUC > 140 mg/dL/min was statistically higher in patients on POST (43.70 mg/dL/min; 95%CI: 34.08 to 53.31) versus PRE insulin aspart regimen (37.24 mg/dL/min 95%CI: 27.63 to 46.85) ( P = 0.03). Mean interstitial glycemia and glycemic variability indices were also increased ( P < 0.05) on POST regimen. The mean AUC 4 hours after the high fat meal was higher on POST regimen but not statistically different ( P = 0.06). Conclusions In our study, postprandial administration of insulin aspart appears to mildly increase glycemic excursion and glycemic variability.