榴莲视频

ORLANDO -- For patients on long-acting basal insulin degludec (Tresiba), a faster-acting insulin bolus at mealtimes was as effective as a regular bolus but didn't improve overall glucose control in type 1 diabetes, a double-blind randomized trial showed at the American Diabetes Association (ADA) meeting here.

In the 1,025-patient trial, the fast-acting insulin aspart (Fiasp) was affirmed to meet noninferiority but not superiority to regular insulin aspart (NovoLog) for HbA1c at 26 weeks, reported John Buse, MD, PhD, of the University of North Carolina at Chapel Hill. As a secondary endpoint, 1-hour postprandial glucose levels were superior in the faster aspart group (-16.2 mg/dL, 95% CI -24.4 to -8.1).

Giving the faster mealtime insulin after the meal rather than at the beginning of it was also on par with regular insulin aspart, without the 1-hour postprandial advantage, leading Buse to suggest considering it for people with special circumstances, such as those who don't do well with meal planning or those worried about getting interrupted with meals due to work or young children. Hypoglycemia and adverse events were similar across groups.

"It was challenging to demonstrate a reduction in HbA1c, and it always has been, frankly, as we've gotten to better and better forms of insulin," Buse told attendees at the session.

Kidney Disease Risk Factors

While poorer type 1 diabetes control and longer duration are risk factors for kidney disease in type 1 diabetes, so are socioeconomics, the T1D Exchange clinic-based registry showed. Of the 3,296 patients with 5 years of follow-up without albuminuria or abnormal kidney function at baseline, 6.8% developed micro- or macroalbuminuria, 8.3% developed an eGFR under 60 ml/min, and 1.5% developed a combination of both.

Significant independent risk factors included:

• Older age
• Longer type 1 diabetes duration
• Earlier age at type 1 diabetes onset
• Lower achieved education
• Higher hemoglobin A1c
• Higher systolic blood pressure

"Most surprising was the impact of socioeconomic status on progression of kidney disease. Also, in univariate analysis, patients using continuous glucose monitors but not pumps had less diabetic kidney disease," study presenter Janet McGill, MD, of Washington University School of Medicine in St. Louis, told 榴莲视频 at the ADA meeting.

The findings suggest that clinicians "continue efforts to achieve excellent glucose control using all tools available. Also, be available to assist patients with lower socioeconomic status," she said.

Novel Insulin Mix

The novel BioChaperone Combo formulation that allows a mix of mealtime insulin lispro (Humalog) and basal insulin glargine (Lantus) improved postprandial glucose control in type 2 diabetes patients compared with either the currently available lispro mix, or glargine plus lispro given individually, according to a 36-patient pharmacodynamic and pharmacokinetic study.

"So far, it has been impossible to design a premix insulin with insulin glargine as basal component due to the reduced solubility of insulin glargine at neutral pH," noted Tim Heise, MD, of the private research institute Profil in Neuss, Germany, and colleagues in their presentation at ADA.

Insulin concentrations rose faster, with a higher exposure over the first 2 hours after a test meal with the combo, but then lower exposure to 6 hours for less time in hypoglycemia compared to the lispro mix.

The findings suggest use "may enable treatment intensification for patients on basal insulin," Heise told attendees.