Diabetes Metab J.  2023 Jan;47(1):72-81. 10.4093/dmj.2022.0035.

Performance of Fast-Acting Aspart Insulin as Compared to Aspart Insulin in Insulin Pump for Managing Type 1 Diabetes Mellitus: A Meta-Analysis

• Dutta D
• Mohindra R
• Mahajan K
• Sharma M

• KMID: 2538932
• DOI: http://doi.org/10.4093/dmj.2022.0035

Abstract

Background
No meta-analysis has analysed efficacy and safety of fast-acting aspart insulin (FIAsp) with insulin pump in type 1 diabetes mellitus (T1DM).
Methods
Electronic databases were searched for randomised controlled trials (RCTs) involving T1DM patients on insulin pump receiving FIAsp in intervention arm, and placebo/active comparator insulin in control arm. Primary outcome was to evaluate changes in 1- and 2-hour post-prandial glucose (1hPPG and 2hPPG). Secondary outcomes were to evaluate alterations in percentage time with blood glucose <3.9 mmol/L (hypoglycaemia), time in range (TIR) blood glucose 3.9 to 10 mmol/L, insulin requirements and adverse events.
Results
Data from four RCTs involving 640 patients was analysed. FIAsp use in insulin pump was associated with significantly greater lowering of 1hPPG (mean difference [MD], –1.35 mmol/L; 95% confidence interval [CI], –1.72 to –0.98; P<0.01; I²=63%) and 2hPPG (MD, –1.19 mmol/L; 95% CI, –1.38 to –1.00; P<0.01; I²=0%) as compared to controls. TIR was comparable among groups (MD, 1.06%; 95% CI, –3.84 to 5.96; P=0.67; I²=70%). Duration of blood glucose <3.9 mmol/L was lower in FIAsp group, approaching significance (MD, –0.91%; 95% CI, –1.84 to 0.03; P=0.06; I²=0%). Total hypoglycaemic episodes (risk ratio [RR], 1.35; 95% CI, 0.55 to 3.31; P=0.51; I²=0%), severe hypoglycaemia (RR, 2.26; 95% CI, 0.77 to 6.66; P=0.14), infusion site reactions (RR, 1.35; 95% CI, 0.63 to 2.93; P=0.77; I²=0%), and treatment-emergent adverse events (RR, 1.13; 95% CI, 0.80 to 1.60; P=0.50; I²=0%) were comparable.
Conclusion
FIAsp use in insulin pump is associated with better post-prandial glycaemic control with no increased hypoglycaemia or glycaemic variability.

Keyword

Diabetes mellitus, type 1; Hypoglycemia; Insulin; Meta-analysis

Figure

• 

  Fig. 1. (A) Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies. (B) Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

• 

  Fig. 2. Forest plot highlighting the impact of fast-acting aspart insulin (FIAsp) as compared to aspart insulin on (A) 1-hour postprandial glucose, (B) 2-hour post-prandial glucose, (C) total daily bolus insulin, and (D) total daily insulin requirement. SD, standard deviation; IV, inverse variance; CI, confidence interval.

• 

  Fig. 3. Forest plot highlighting the impact of fast-acting aspart insulin (FIAsp) as compared to aspart insulin on (A) percent time in hypoglycaemia range (blood glucose <3.9 mmol/L), (B) time in range (blood glucose 3.9 to 10 mmol/L), (C) total hypoglycaemia episodes, and (D) severe hypoglycaemia episodes. SD, standard deviation; IV, inverse variance; CI, confidence interval; M-H, Mantel-Haenszel.

• 

  Fig. 4. Forest plot highlighting the impact of fast-acting aspart insulin (FIAsp) as compared to aspart insulin on (A) treatment-emergent adverse events, (B) severe adverse events, (C) infusion site reactions, and (D) occlusion events. M-H, Mantel-Haenszel; CI, confidence interval.

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