Endocrine Abstracts

Introduction: Postprandial glycemic control is complex as well as insufficient. Its impact on global metabolic control (HbA1c) is controversial with various works that support its influence in terms of glycemic variability and genesis of micro and/or macrovascular complications. Fiasp due to its special formulation allows a more effective control of postprandial glycemia being an interesting alternative to the rapid-acting insulin analogavailable.

Objective: To assess the impact of FIASP insulin on global metabolic control (HbA1c) and patient adherence to this new formulation.

Materials and methods: Prospective study of 82 patients with DM followed up in two hospitals in Granada whose initial ‘fast’ insulin was replaced by FIASP. Two groups are theorized: 1. HbA1c > 8.5% (greater influence of poor control of basal glycemia) and 2. HbA1c < 8.5% (greater influence of poor postprandial control). The statistical study was carried out with the SPSS15 program.

Results: 82 patients (52.4% women) with a mean age of 41.54 ± 16.9 years. Evolution time of DM of 15.9 ± 9.40 years. 78% of DM1 patients, all in bolus basal regimen. Average basal insulin dose of 30.47 ± 14.89 IU (0.42 IU/kg). Basal ‘fast’ insulin: 8% aspart, 16.9% glulisine, 20.9% lispro and 1.2% human rapid. Baseline HbA1c and blood glucose values of 8.65 ± 1.49% and 148.23 ± 71.34 mg/dl respectively. After a mean follow-up of 7.9 ± 3.5 months (67 patients with data available at follow-up), HbA1c and baseline blood glucose values were 8.20 ± 1.22% (P < 0.05) and 132, 67 ± 62.71 mg/dl (NS) respectively. A greater decrease in HbA1c was observed in those patients with baseline HbA1c > 8.5 (P < 0.05). During the follow-up, 26.8% of the patients needed to decrease the doses with respect to the rapid insulin they used previously and 12.2% decided to stop Fiasp and return to their initial rapid insulin.

Conclusions: Fiasp improved metabolic control in a large group of patients with DM, especially in the group with baseline HbA1c > 8.5. Adequate information to the patient about the characteristics of said insulin is necessary in order to increase adherence and achieve the potential benefits expected with this formulation.