Effect of Ultra-rapid Insulin Aspart on Glycemic Control in Children with Type 1 Diabetes: the Experience of a Portuguese Tertiary Centre

Background: Postprandial hyperglycemia is one of the biggest challenges in children with type 1 diabetes (T1D). Ultra-fast-acting aspartic insulin (faster aspart) has a quicker onset of action and an earlier maximum activity. The aim of this study is to analyze the impact of faster aspart in metabolic control of pediatric patients with T1D in a "real-world" setting.

Methods: Retrospective analysis of 60 pediatric patients with T1D who changed their insulin analogue to faster aspart. Anthropometric data, insulin doses, capillary and interstitial glucose recordings and average glycated hemoglobin before and after insulin analogue's switch were obtained. After all population analyses, patients were analyzed separately according to the type of treatment, multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and according to age group.

Results: Faster aspart significantly improved metabolic control, increasing time in range (TIR) (42 vs.54%, respectively;  = 0.007) and decreasing time above range (TAR) (52 vs.40%, respectively;  = 0.009), without an increased time in hypoglycemia (7% before and after faster aspart's introduction;  = 0.933). This was reassured in the adolescent years ( = 45), with an increase in TIR (37 vs. 47%, respectively;  = 0.034) and decrease in TAR (51 vs. 45%, respectively;  = 0.022). Patients on CSII ( = 47), also demonstrated an increase in TIR (38 vs. 50%, respectively;  = 0.010). The reduction of A1c was not statistically significant.

Conclusion: Although the advantage of faster aspart had already been demonstrated in pediatric patients under MDI, "real-world" studies, including patients under CSII, are still lacking. This study highlights the important impact of faster aspart on metabolic control in children with T1D, particularly among adolescents under CSII.