Insulin glargine

Insulin aspart

Type 2 diabetes

Insulin degludec

Endocrinology

Hypoglycemia

Insulin

Environmental health

Discontinuation

Insulin detemir

Postprandial

Population

Internal medicine

Clinical endpoint

Type 1 diabetes

Glycated hemoglobin

Medicine

Randomized controlled trial

Diabetes mellitus

Diabetes Care

OBJECTIVE To confirm efficacy and safety of fast-acting insulin aspart (faster aspart) versus insulin aspart (IAsp), both with basal insulin degludec, in a pediatric population with type 1 diabetes. RESEARCH DESIGN AND METHODS After a 12-week run-in, this treat-to-target, 26-week, multicenter trial randomized participants (1 to &amp;lt;18 years) to double-blind mealtime faster aspart (n = 260), mealtime IAsp (n = 258), or open-label postmeal faster aspart (n = 259). The primary end point was change from baseline in glycated hemoglobin (HbA1c) after 26 weeks of treatment. All available information regardless of treatment discontinuation was used for the evaluation of treatment effect. RESULTS At week 26, mealtime and postmeal faster aspart were noninferior to IAsp regarding change from baseline in HbA1c (P &amp;lt; 0.001 for noninferiority [0.4% margin]), with a statistically significant difference in favor of mealtime faster aspart (estimated treatment difference −0.17% [95% CI −0.30; −0.03], −1.82 mmol/mol [−3.28; −0.36]; P = 0.014). Change from baseline in 1-h postprandial glucose increment significantly favored mealtime faster aspart versus IAsp at breakfast, main evening meal, and over all meals (P &amp;lt; 0.01 for all). No statistically significant differences in the overall rate of severe or blood glucose–confirmed hypoglycemia were observed. Mean total daily insulin dose was 0.92 units/kg for mealtime faster aspart, 0.92 units/kg for postmeal faster aspart, and 0.88 units/kg for mealtime IAsp. CONCLUSIONS In children and adolescents with type 1 diabetes, mealtime and postmeal faster aspart with insulin degludec provided effective glycemic control with no additional safety risks versus IAsp. Mealtime faster aspart provided superior HbA1c control compared with IAsp.

Efficacy and Safety of Fast-Acting Insulin Aspart Compared With Insulin Aspart, Both in Combination With Insulin Degludec, in Children and Adolescents With Type 1 Diabetes: The onset 7 Trial