Ultra-rapid-acting insulins for adults with diabetes mellitu
Researchers performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy and safety of the novel, ultra-rapid acting insulins aspart and lispro in adults with type 1 or type 2 diabetes.

The primary outcome was change in HbA1c from baseline. They additionally assessed eight efficacy and six safety endpoints. They calculated weighted mean differences (WMD) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, alongside 95% confidence intervals (CIs).

They additionally assessed statistical heterogeneity among studies with the I2 statistic, considering values greater than 60% indicative of substantial heterogeneity. Nine studies comprising 5931 patients were included in the systematic review; eight active-controlled studies could be synthesized in terms of a meta-analysis.

Treatment with ultra-rapid acting insulins had a similar effect on change in HbA1c, compared with rapid-acting insulins (WMD -0.02 %, 95% CI -0.08 to 0.05, I2=61% for patients with type 1 diabetes and -0.02 %, 95% CI -0.09 to 0.04, I2=19% for patients with type 2 diabetes). Similarly, no difference was evident in terms of change in fasting plasma glucose, self-measured plasma glucose, body weight, basal or bolus insulin dose, incidence of serious adverse events and hypoglycaemia.

Compared with rapid-acting insulins, ultra-rapid insulins reduced 1-hour and 2-hour postprandial glucose (PPG) increment based on a liquid meal test, both in patients with type 1 and type 2 diabetes (WMD -0.94 mmol/L, 95% CI -1.17 to -0.72, I2=0% and -0.56 mmol/L, 95% CI -0.79 to -0.32, I2=0%, respectively for change in 1-hour PPG increment).

In conclusion, ultra-rapid acting insulins were as efficacious and safe as rapid-acting insulins, demonstrating a favourable effect solely on PPG control.

Source: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14461?af=R
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