Introduction: The first multi-center randomised trial looking at the efficacy and safety of Insulin Aspart, a faster acting insulin which aims to mimic endogenous prandial insulin action, was published in May 2019. We report our experience of using Insulin Aspart in the Norfolk and Norwich University Hospital childrens diabetes clinic.
Methods: Children and young people with type 1 diabetes seen the Norfolk and Norwich paediatric diabetes service (total patient population aged 019 years 289 individuals) were invited to change from Novorapid to Insulin Aspart between May and September 2017. Consent was taken from patients and their families for the unlicensed use of Insulin Aspart. Data including point of care HbA1C mmol/mol, percentage time in target (49 mmol/l) and percentage time below target (<4 mmol/l) was collected as part of routine clinic follow up.
Results: Forty-eight children and adolescents (25 male) with type 1 diabetes aged a median of 11.3 years (standard deviation 3.8 years) elected to change to Insulin Aspart. Median time since diagnosis was 3.9 years (range 114 years). To make decisions regarding insulin therapy twelve children used DEXCOM CGMS, twenty Libre FGM and sixteen blood glucose testing strips. HbA1C was 58.4 mmol/mol at baseline (S.D. 9.5), and 58.9 mmol/mol (S.D. 11.4) at 9 months (P=0.8). In patients using DEXCOM/CGMS, time in target was 51.5% at baseline and 47% (P=0.8) at 9 months and time below target was 6% at baseline and 5% (P=0.8) at 9 months. Anecdotally patients reported that contrary to expectations Insulin Aspart needed to be administered 1520 min prior to food to manage the post prandial rise. Six children stopped Insulin Aspart during the 1.5 year follow up period. One individual stopped insulin Aspart due to the development of severe lipodystrophy after 18 months of treatment, one developed a localised allergic rash and one reported frequent cannula blockages.
Conclusion: Overall Insulin Aspart was well tolerated. We saw no significant difference in HbA1C in the patients on Aspart with no significant improvement in time in/below target. Further data should be collected with regard to the optimal timing of Insulin Aspart in relation to meal times.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes