open access

Vol 8, No 6 (2019)
ORIGINAL ARTICLES
Published online: 2020-01-23
Get Citation

A case study of eight type 2 diabetic stage 4 chronic kidney disease patients showing lower glycemic variability with faster-acting insulin aspart as compared to insulin aspart

Sayak Roy, Camelia Biswas, Mridul Bera, Guruprasad Bhattacharya
DOI: 10.5603/DK.2019.0027
·
Clinical Diabetology 2019;8(6):284-291.

open access

Vol 8, No 6 (2019)
ORIGINAL ARTICLES
Published online: 2020-01-23

Abstract

Background. Peaks and nadirs of blood glucose level varying daily in a person is referred to as glycemic variability (GV). GV associated with diabetics has been recently linked to cardiovascular disorders (CVD) or even chronic kidney disease (CKD) progression. Faster-acting insulin aspart is the latest ultra-rapid acting bolus insulin which has shown much lesser intra- and inter-patient variability as compared to conventional bolus insulin.

Material and methods. However, inadequate data exist regarding GV in patients with advanced stages of CKD. Hence, with this objective, the present case study was undertaken with eight patients divided into two equal groups, wherein faster-acting insulin aspart and insulin aspart were used as the boluses, respectively. Continuous glucose monitoring data of the patients were taken for the initial four days to calculate mean amplitude of glycemic excursion (MAGE) of the total four days for each individual (mmol/L) to see the difference in GV. A value of > 3.607 mmol/L (65 mg/dL) was considered to be statistically significant.

Results. In this case study of eight stage 4 CKD type 2 diabetic patients, statistically significant lower GV was observed in the faster-acting insulin aspart arm when compared with the insulin aspart arm. The pvalue was 0.0004 in unpaired t-test and < 0.05 for U in Mann-Whitney U test after ruling out the baseline confounding factors.

Conclusions. This study confirms the stable pharmacokinetic and dynamic properties of faster-acting insulin aspart and subsequent studies with larger numer of patients are required for a conclusive outcome.

Abstract

Background. Peaks and nadirs of blood glucose level varying daily in a person is referred to as glycemic variability (GV). GV associated with diabetics has been recently linked to cardiovascular disorders (CVD) or even chronic kidney disease (CKD) progression. Faster-acting insulin aspart is the latest ultra-rapid acting bolus insulin which has shown much lesser intra- and inter-patient variability as compared to conventional bolus insulin.

Material and methods. However, inadequate data exist regarding GV in patients with advanced stages of CKD. Hence, with this objective, the present case study was undertaken with eight patients divided into two equal groups, wherein faster-acting insulin aspart and insulin aspart were used as the boluses, respectively. Continuous glucose monitoring data of the patients were taken for the initial four days to calculate mean amplitude of glycemic excursion (MAGE) of the total four days for each individual (mmol/L) to see the difference in GV. A value of > 3.607 mmol/L (65 mg/dL) was considered to be statistically significant.

Results. In this case study of eight stage 4 CKD type 2 diabetic patients, statistically significant lower GV was observed in the faster-acting insulin aspart arm when compared with the insulin aspart arm. The pvalue was 0.0004 in unpaired t-test and < 0.05 for U in Mann-Whitney U test after ruling out the baseline confounding factors.

Conclusions. This study confirms the stable pharmacokinetic and dynamic properties of faster-acting insulin aspart and subsequent studies with larger numer of patients are required for a conclusive outcome.

Get Citation

Keywords

type 2 diabetes mellitus, faster-acting insulin aspart, glycemic variability, mean amplitudę of glucose excursion, chronic kidney disease, continuous glucose monitoring system

About this article
Title

A case study of eight type 2 diabetic stage 4 chronic kidney disease patients showing lower glycemic variability with faster-acting insulin aspart as compared to insulin aspart

Journal

Clinical Diabetology

Issue

Vol 8, No 6 (2019)

Pages

284-291

Published online

2020-01-23

DOI

10.5603/DK.2019.0027

Bibliographic record

Clinical Diabetology 2019;8(6):284-291.

Keywords

type 2 diabetes mellitus
faster-acting insulin aspart
glycemic variability
mean amplitudę of glucose excursion
chronic kidney disease
continuous glucose monitoring system

Authors

Sayak Roy
Camelia Biswas
Mridul Bera
Guruprasad Bhattacharya

References (18)
  1. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009; 373(9677): 1798–1807.
  2. Cavalot F, Pagliarino A, Valle M, et al. Postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a 14-year follow-up: lessons from the San Luigi Gonzaga Diabetes Study. Diabetes Care. 2011; 34(10): 2237–2243.
  3. Sartore G, Chilelli NC, Burlina S, et al. The importance of HbA1c and glucose variability in patients with type 1 and type 2 diabetes: outcome of continuous glucose monitoring (CGM). Acta Diabetol. 2012; 49 Suppl 1: S153–S160.
  4. Suh S, Kim JH. Glycemic Variability: How Do We Measure It and Why Is It Important? Diabetes Metab J. 2015; 39(4): 273–282.
  5. Satya Krishna SV, Kota SK, Modi KD. Glycemic variability: Clinical implications. Indian J Endocrinol Metab. 2013; 17(4): 611–619.
  6. Fiaspinsulin aspart injection 100 units/mL.Fiasp. 2018;1-12. Available at: https://www.novo-pi.com/fiasp.pdf.
  7. Akasaka T, Sueta D, Tabata N, et al. Effects of the Mean Amplitude of Glycemic Excursions and Vascular Endothelial Dysfunction on Cardiovascular Events in Nondiabetic Patients With Coronary Artery Disease. J Am Heart Assoc. 2017; 6(5).
  8. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321(7258): 405–412.
  9. Jeha GS, Karaviti LP, Anderson B, et al. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther. 2005; 7(6): 876–884.
  10. Hypoglycemia in the diabetes control and complications trial. The Control and Complications Trial Research Group. Diabetes. 1997; 46(2): 271–286.
  11. Eslami S, Taherzadeh Z, Schultz MJ, et al. Glucose variability measures and their effect on mortality: a systematic review. Intensive Care Med. 2011; 37(4): 583–593.
  12. Muggeo M, Verlato G, Bonora E, et al. Long-term instability of fasting plasma glucose, a novel predictor of cardiovascular mortality in elderly patients with non-insulin-dependent diabetes mellitus: the Verona Diabetes Study. Circulation. 1997; 96(6): 1750–1754.
  13. Kim YS, Kim C, Jung KH, et al. Range of glucose as a glycemic variability and 3-month outcome in diabetic patients with acute ischemic stroke. PLoS One. 2017; 12(9): e0183894.
  14. DeVries JH. Glucose variability: where it is important and how to measure it. Diabetes. 2013; 62(5): 1405–1408.
  15. Tong L, Chi C, Zhang Z. Association of various glycemic variability indices and vascular outcomes in type-2 diabetes patients: A retrospective study. Medicine (Baltimore). 2018; 97(21): e10860.
  16. Roy S, Bera M, Bhattacharya G, et al. Switch-over study with fast-acting insulin aspart showing lower glycemic variability in type 2 diabetics with stage 4 chronic kidney disease: a case series. Cureus. 2019; 11(12): e6344.
  17. De Block C, Carlson A, Rose L, et al. Hypoglycemia with mealtime fast-acting insulin aspart vs. Insulin aspart across two large type 1 diabetes trials. Diabetes. 2018; 67(Supplement 1).
  18. Heise T, Pieber TR, Danne T, et al. 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. 2017; 56(5): 551–559.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl