Non-glycemic effects of insulin therapy: a comparison between insulin aspart and regular human insulin during two consecutive meals in patients with type 2 diabetes

Abstract

Objective: To control postprandial hyperglycemia in insulin-treated type 2 diabetic patients, prandial therapy with regular human insulin (HI) or fast acting insulin analogs is used. Postprandial hyperglycemia seems to be reduced more effectively with insulin analogs than with normal insulin, but there are no data concerning the effect on lipolysis or pancreatic insulin and proinsulin secretion of normal insulin in comparison to insulin analogs. Design and methods: We included 13 patients with type 2 diabetes mellitus (age 62.2G10.3 years) with preexisting insulin therapy in this crossover, prospective, open-labeled, randomized trial comparing regular HI with insulin aspart (IA) in the setting of a standardized breakfast and a standardized lunch 4 h later. Blood samples for determination of glucose, free fatty acids (FFA), triglycerides, C-peptide, and intact proinsulin were drawn during fasting and every 30 min until 4 h after the second test meal. Statistical analysis was performed with ANOVA for repeated measurements and paired Student's t-test. Results: The mean increase in blood glucose was significantly lower after IA (24.18G16.33 vs 34.92G29.07 mg/dl, PZ0.02) compared with HI. Both therapies reduced FFA; however, the mean reduction was significantly higher after IA than after HI (K0.47G0.16 vs K0.35G0.15 mmol/l, P!0.001). The mean increase in intact proinsulin was significantly lower after IA than after HI (10.53G5 vs 15.20G6.83 pmol/l, P!0.001). No differences were observed in the C-peptide levels between the two groups. Conclusion: In the setting of two consecutive meals, IA reduces lipolysis and proinsulin secretion more effectively than HI.

Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices

“…While no significant differences were observed for average HbA1c (both groups: 58 mmol/mol; 7.5%) and fasting plasma glucose, a significant decrease in 90-min postprandial glucose was found in patients on insulin aspart compared with those on regular insulin (142 ± 58 vs. 226 ± 48 mg/dl). Randomized controlled trials were able to show a better improvement of postprandial glycaemic control with aspart than with regular human insulin in patients with type 2 diabetes [5,14]. Postprandial glycaemic excursions were 20% lower with insulin aspart compared with regular human insulin, which is due to a higher amount of bio-available insulin and a shorter time period to reach the maximum serum insulin concentration [5].…”

“…Randomized controlled trials were able to show a better improvement of postprandial glycaemic control with aspart than with regular human insulin in patients with type 2 diabetes . Postprandial glycaemic excursions were 20% lower with insulin aspart compared with regular human insulin, which is due to a higher amount of bio‐available insulin and a shorter time period to reach the maximum serum insulin concentration .…”

Rapid-Acting Insulin Analogues Versus Regular Human Insulin: A Meta-Analysis of Effects on Glycemic Control in Patients with Diabetes

“…For example, a randomised, multicentre study of 29 patients with T2D who received insulin aspart or RHI at a dose aimed at achieving a PPG below 140 mg/dL for 24 months showed that for the first 9 months of the study, patients receiving insulin aspart who had PPG levels of less than 140 mg/dL were on a significantly lower dose than those receiving RHI who achieved the same endpoint [47]. A randomised crossover trial involving 13 patients with T2D who received insulin aspart or RHI demonstrated a significantly lower BG increase after a standardised meal with insulin aspart versus RHI [48]. Subanalyses of the A 1 chieve and IMPRO-VE TM studies showed that switching from RHI to insulin aspart led to significant decreases in both HbA1c and PPG [49,50].…”