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Efficacy and safety of ultra-rapid insulin analogues in insulin pumps in patients with Type 1 Diabetes Mellitus: A systematic review and meta-analysis

  • Athina Stamati
    Correspondence
    Corresponding author at: 106, Mitropoleos str, 54621 Thessaloniki, Greece.
    Affiliations
    Postgraduate Program “Research Methodology in Medicine and in Health Sciences”, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Thomas Karagiannis
    Affiliations
    Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Apostolos Tsapas
    Affiliations
    Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • Athanasios Christoforidis
    Affiliations
    1st Paediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
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Published:November 06, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110144

      Highlights

      • FIAsp and URLi increase time spent in normoglycaemia (70–180 mg/dl) and decrease time spent in hypoglycaemia (<70 mg/dl).
      • FIAsp and URLi show to be more effective for post-prandial glucose control.
      • Unplanned infusion set changes were more frequent with FIAsp and URLi in sensor-augmented pumps systems.

      Abstract

      Aims

      To assess the efficacy and safety of ultra-rapid insulin analogues used with continuous subcutaneous insulin infusion systems (CSII) in adults with type 1 diabetes (T1DM).

      Methods

      We searched MEDLINE and Cochrane Library up to May 2022 for randomized controlled trials comparing ultra-rapid with rapid-acting insulin analogues (RAIAs) used with CSII. We performed random effects meta-analyses for % of 24-h time in range of 70–180 mg/dl (TIR), time in hypoglycaemia (<70 mg/dl) and hyperglycaemia (>180 mg/dl), 1- and 2-hour post-prandial glucose [PPG] increment after a meal test, HbA1c and average insulin dose at endpoint, unplanned infusion set changes and severe hypoglycaemia.

      Results

      Nine studies (1,156 participants) were included. Ultra-rapid insulins were superior to RAIAs on TIR (mean difference [MD] 1.1 %, 95 % CI 0.11–2.11), time spent in hypoglycaemia (MD −0.47 %, 95 % CI −0.63 to −30), and 1- and 2-hour PPG (MD −12.20 mg/dl, 95 % CI −19.85 to −4.54 and MD −17.61 mg/dl, 95 % CI −28.55 to −6.66, respectively). Ultra-rapid insulins increased odds of unplanned infusion set changes (odds ratio 1.60, 95 % CI 1.26–2.03).

      Conclusion

      Ultra-rapid acting insulins provided better PPG control compared to RAIAs but their use might result in more infusion set changes.

      Keywords

      Abbreviations:

      CGM (Continuous glucoe monitoring), CI (Confidence interval), CSII (Continuous subcutaneous insulin infusion), FIAsp (Fast-acting insulin aspart), HbA1c (Glycated haemoglobin), HCLS (Hybrid closed-loop system), IAsp (Insulin aspart), MD (Mean difference), OR (Odds ratio), PPG (Post-prandial glucose), RAIAs (Rapid-acting insulin analogues), RCT (Randomized controlled trial), SAP (Sensor-augmented pump), T1DM (Type 1 diabetes mellitus), TIR (Time in range), URLi (Ultra-rapid lispro)
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