Effectiveness of Faster Aspart versus Insulin Aspart in Children with Type 1 Diabetes: A Meta-Analysis
Abstract
Background: Intensive insulin regimens are recommended to achieve glycemic goals in children and adolescents with type 1 diabetes. Fast-acting insulin aspart (faster aspart) is a new formulation of insulin aspart (IAsp) in which L-arginine and niacinamide are added to assure formulation stability, early absorption, and ultra-fast action. This meta-analysis compares faster aspart with IAsp for blood sugar control in children with type 1 diabetes. This study suggested treating diabetes with insulin, especially in children with type 1 diabetes.
Methods: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar were searched from 2000 to 2023 without language restrictions. Blood glucose monitoring, HbA1c, care model, insulin aspart, IAsp, faster aspart, type 1 diabetes, and pediatrics are Mesh keywords. Cochrane Q statistics and index tested heterogeneity. To account for heterogeneity, Q=145.99 (P-value < 0.001) and =97.26%, and the random-effect model was used to aggregate primary study results. The meta-analysis of randomized-controlled trials was conducted in accordance with PRISMA standards.
Results: The overall estimate measure i.e. mean difference was found to be 5.44 [0.45, 10.44] and 7.71 [7.16, 8.26] which indicate significant reduction in the HbA1C level in the fast acting insulin aspart group as compared to the IAsp in T1D. However, the mean difference with respect to BMI was found to be -0.06 [-0.60, 0.48] which indicate non-significant reduction.
Conclusion: Faster aspart had faster onset and more early exposure than IAsp in children and adolescents with greater and more variable anti-insulin antibody levels than adults did. Hence fast-acting insulin aspart may provide better glucose control than IAsp in T1D.
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12. Batchelor HK, Marriott JF (2015). Paediatric pharmacokinetics: key considerations. Br J Clin Pharmacol, 79(3):395-404. doi: 10.1111/bcp.12267
13. Workgroup on Hypoglycemia, American Diabetes Association (2005). Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care, 28(5), 1245–1249. https://doi.org/10.2337/diacare.28.5.1245
14. Kumar A. Meta-analysis in Clinical Research: Principles and Procedures. Springer Singapore. 2023. ISBN: 978-981-99-2369-4. https://doi.org/10.1007/978-981-99-2370-0.
15. Srivastava R & Kumar A (2021). Use of aspirin in reduction of mortality of COVID‐19 patients: A meta‐analysis. Int J Clin Pract, 75(11), e14515.
16. Thakur M, Datusalia AK, Kumar A (2022). Use of steroids in COVID-19 patients: A meta-analysis. Eur J Pharmacol, 914, 174579.
17. Singh RK (2013). A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer. Int J Clin Med Res, 1(3):11. https://doi.org/10.61466/ijcmr1030011
18. Fath M, Danne T, Biester T, Erichsen L, Kordonouri O, Haahr H (2017). Faster-acting insulin aspart provides faster onset and greater early exposure vs insulin aspart in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes, 18(8):903-910. doi:10.1111/pedi.12506
19. Danne T, Phillip M, Buckingham BA, et al (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes, 19 Suppl 27:115-135. doi:10.1111/pedi.12718
20. Chiang JL, Maahs DM, Garvey KC, et al (2018). Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care, 41(9), 2026–2044. https://doi.org/10.2337/dci18-0023
21. Cengiz E (2012). Undeniable need for ultrafast-acting insulin: the pediatric perspective. J Diabetes Sci Technol, 6(4):797-801. doi:10.1177/193229681200600409
22. Biester T, Kordonouri O, Danne T (2018). Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?. Ther Adv Endocrinol Metab, 9(5):157-166. doi:10.1177/2042018818763247
23. Onda Y, Sugihara S, Ogata T, et al. (2017). Incidence and prevalence of childhood-onset Type 1 diabetes in Japan: the T1D study. Diabet Med, 34(7):909-915. doi:10.1111/dme.13295
24. Heise T, Pieber TR, Danne T, Erichsen L, Haahr H (2017). A Pooled Analysis of Clinical Pharmacology Trials Investigating the Pharmacokinetic and Pharmacodynamic Characteristics of Fast-Acting Insulin Aspart in Adults with Type 1 Diabetes. Clin Pharmacokinet, 56(5):551-559. doi:10.1007/s40262-017-0514-8
25. Bode BW, Iotova V, Kovarenko M, et al (2019). 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. Diabetes Care, 42(7):1255-1262. doi:10.2337/dc19-0009
26. Kawamura T, Kikuchi T, Horio H, Rathor N, Ekelund M (2021). Efficacy and safety of fast-acting insulin aspart versus insulin aspart in children and adolescents with type 1 diabetes from Japan. Endocr J, 68(4):409-420. doi:10.1507/endocrj.EJ20-0116
27. Biester T, von dem Berge T, Bendtsen LQ, et al (2020). The association between anti-insulin aspart antibodies and the pharmacokinetic and pharmacodynamic characteristics of fast-acting insulin aspart in children and adolescents with type 1 diabetes. Pediatr Diabetes, 21(5):781-790. doi:10.1111/pedi.13026
28. Girsh, Y., Kiyaev AV, Slovak MA, et al (2022). Comparative assessment of modern parameters of glycemic control in children with type 1 diabetes after switching to fast-acting insulin aspart using Flash Glucose Monitoring in real clinical practice. Diabetes Mellitus, 25(5):458-467. (In Russ.) https://doi.org/10.14341/DM12838
29. Bowering K, Rodbard HW, Russell-Jones D, et al (2019). Investigating the Association Between Baseline Characteristics (HbA1c and Body Mass Index) and Clinical Outcomes of Fast-Acting Insulin Aspart in People with Diabetes: A Post Hoc Analysis. Diabetes Ther, 10(1):177-188. doi:10.1007/s13300-018-0553-7.
2. Karvonen M, Viik-Kajander M, Moltchanova E, et al (2000). Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care, 23(10):1516-1526. https://doi.org/10.2337/diacare.23.10.1516
3. Sharma S, Rehman Ansari MH, Sharma K, et al (2023). Pyrazoline scaffold: hit identification to lead synthesis and biological evaluation as antidiabetic agents. Future Med Chem, 15(1):9-24.
4. Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G. EURODIAB Study Group (2009). Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet. 373(9680):2027-2033. doi:10.1016/S0140-6736(09)60568-7
5. Patterson CC, Harjutsalo V, Rosenbauer J, et al (2019). Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989-2013: a multicentre prospective registration study. Diabetologia, 62(3):408-417. doi:10.1007/s00125-018-4763-3
6. Ogurtsova K, Guariguata L, Barengo NC, et al (2022). IDF diabetes Atlas: Global es-timates of undiagnosed diabetes in adults for 2021. Diabetes Res Clin Pract, 183, 109118.
7. World Diabetes Day. https://worlddiabetesday.org/about/facts-figures. Accessed on 05 September 2023
8. Campbell MS, Schatz DA, Chen V, et al (2014). A contrast between children and adolescents with excellent and poor control: the T1D Exchange clinic regis-try experience. Pediatr Diabetes, 15(2):110-117. doi:10.1111/pedi.12067
9. Craig ME, Prinz N, Boyle CT, et al (2017). Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes: International Comparison Across Three Continents. Diabetes Care, 40(8):1034-1040. doi:10.2337/dc16-2508
10. Heise T, Hövelmann U, Brøndsted L, Adrian CL, Nosek L, Haahr H (2015). Faster-acting insulin aspart: earlier onset of appearance and greater early pharmacokinetic and pharmacodynamic effects than insulin aspart. Diabetes Obes Metab, 17(7):682-688. doi:10.1111/dom.12468
11. Scala M, Koob M, de Buttet S, Bourrinet P, Felices M, Jurkiewicz E (2018). A Pharmacokinetics, Efficacy, and Safety Study of Gadoterate Meglumine in Pediatric Subjects Aged Younger Than 2 Years. Invest Radiol, 53(2):70-79. doi:10.1097/RLI.0000000000000412
12. Batchelor HK, Marriott JF (2015). Paediatric pharmacokinetics: key considerations. Br J Clin Pharmacol, 79(3):395-404. doi: 10.1111/bcp.12267
13. Workgroup on Hypoglycemia, American Diabetes Association (2005). Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care, 28(5), 1245–1249. https://doi.org/10.2337/diacare.28.5.1245
14. Kumar A. Meta-analysis in Clinical Research: Principles and Procedures. Springer Singapore. 2023. ISBN: 978-981-99-2369-4. https://doi.org/10.1007/978-981-99-2370-0.
15. Srivastava R & Kumar A (2021). Use of aspirin in reduction of mortality of COVID‐19 patients: A meta‐analysis. Int J Clin Pract, 75(11), e14515.
16. Thakur M, Datusalia AK, Kumar A (2022). Use of steroids in COVID-19 patients: A meta-analysis. Eur J Pharmacol, 914, 174579.
17. Singh RK (2013). A meta-analysis of the impact on gastrectomy versus endoscopic submucosal dissection for early stomach cancer. Int J Clin Med Res, 1(3):11. https://doi.org/10.61466/ijcmr1030011
18. Fath M, Danne T, Biester T, Erichsen L, Kordonouri O, Haahr H (2017). Faster-acting insulin aspart provides faster onset and greater early exposure vs insulin aspart in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes, 18(8):903-910. doi:10.1111/pedi.12506
19. Danne T, Phillip M, Buckingham BA, et al (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes, 19 Suppl 27:115-135. doi:10.1111/pedi.12718
20. Chiang JL, Maahs DM, Garvey KC, et al (2018). Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care, 41(9), 2026–2044. https://doi.org/10.2337/dci18-0023
21. Cengiz E (2012). Undeniable need for ultrafast-acting insulin: the pediatric perspective. J Diabetes Sci Technol, 6(4):797-801. doi:10.1177/193229681200600409
22. Biester T, Kordonouri O, Danne T (2018). Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?. Ther Adv Endocrinol Metab, 9(5):157-166. doi:10.1177/2042018818763247
23. Onda Y, Sugihara S, Ogata T, et al. (2017). Incidence and prevalence of childhood-onset Type 1 diabetes in Japan: the T1D study. Diabet Med, 34(7):909-915. doi:10.1111/dme.13295
24. Heise T, Pieber TR, Danne T, Erichsen L, Haahr H (2017). A Pooled Analysis of Clinical Pharmacology Trials Investigating the Pharmacokinetic and Pharmacodynamic Characteristics of Fast-Acting Insulin Aspart in Adults with Type 1 Diabetes. Clin Pharmacokinet, 56(5):551-559. doi:10.1007/s40262-017-0514-8
25. Bode BW, Iotova V, Kovarenko M, et al (2019). 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. Diabetes Care, 42(7):1255-1262. doi:10.2337/dc19-0009
26. Kawamura T, Kikuchi T, Horio H, Rathor N, Ekelund M (2021). Efficacy and safety of fast-acting insulin aspart versus insulin aspart in children and adolescents with type 1 diabetes from Japan. Endocr J, 68(4):409-420. doi:10.1507/endocrj.EJ20-0116
27. Biester T, von dem Berge T, Bendtsen LQ, et al (2020). The association between anti-insulin aspart antibodies and the pharmacokinetic and pharmacodynamic characteristics of fast-acting insulin aspart in children and adolescents with type 1 diabetes. Pediatr Diabetes, 21(5):781-790. doi:10.1111/pedi.13026
28. Girsh, Y., Kiyaev AV, Slovak MA, et al (2022). Comparative assessment of modern parameters of glycemic control in children with type 1 diabetes after switching to fast-acting insulin aspart using Flash Glucose Monitoring in real clinical practice. Diabetes Mellitus, 25(5):458-467. (In Russ.) https://doi.org/10.14341/DM12838
29. Bowering K, Rodbard HW, Russell-Jones D, et al (2019). Investigating the Association Between Baseline Characteristics (HbA1c and Body Mass Index) and Clinical Outcomes of Fast-Acting Insulin Aspart in People with Diabetes: A Post Hoc Analysis. Diabetes Ther, 10(1):177-188. doi:10.1007/s13300-018-0553-7.
| Files | ||
| Issue | Vol 53 No 1 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i1.14680 | |
| Keywords | ||
| Insulin aspart IAsp Faster aspart Diabetes type 1 Care model | ||
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How to Cite
1.
Wei J, Wang Y. Effectiveness of Faster Aspart versus Insulin Aspart in Children with Type 1 Diabetes: A Meta-Analysis. Iran J Public Health. 2023;53(1):23-34.
