Insulin aspart, a rapid-acting human
insulin analogue, provides more rapid absorption than regular human
insulin after subcutaneous administration. In most randomised, nonblind clinical trials in patients with
type 1 diabetes mellitus,
insulin aspart administered immediately before meals resulted in significantly lower mean glycosylated haemoglobin A(1c ) (HbA(1c)) levels than regular human
insulin (usually administered 30 minutes before a meal).
Insulin aspart also significantly improved postprandial glycaemic control compared with regular human
insulin. The efficacy of
insulin aspart was similar to that of
insulin lispro when administered to patients with
type 1 diabetes mellitus via continuous
subcutaneous infusion in a randomised, nonblind trial. Preliminary data from randomised, nonblind trials suggest
insulin aspart had a trend towards lower HbA(1c) levels compared with regular human
insulin in patients with
type 2 diabetes mellitus.
Biphasic insulin aspart [30% soluble (rapid-acting) and 70%
protamine-bound
insulin aspart (
BIAsp30)] generally provided significantly better postprandial
glucose control than a similar mixture of biphasic regular human
insulin (BHI30) in a randomised, nonblind trial in patients with type 1 or 2
diabetes mellitus. However, the long-term efficacy of
BIAsp30 was similar to that of BHI30 after 2 years in a randomised, nonblind trial in patients with
type 2 diabetes mellitus. Patients with type 1 or 2
diabetes mellitus reported greater treatment satisfaction with
insulin aspart or
BIAsp30 than with regular human
insulin or BHI30. The overall incidence of hypoglycaemia with
insulin aspart was lower than, or similar to, that of regular human
insulin. Moreover,
insulin aspart tended to be associated with a lower occurrence of nocturnal hypoglycaemia and severe hypoglycaemic events than regular human
insulin.
CONCLUSION: The standard preparation of
insulin aspart has the potential to better mimic the physiological response to meals than regular human
insulin.
Insulin aspart when combined with a suitable basal
insulin improved overall glycaemic control and led to a similar or lower number of hypoglycaemic episodes compared with a similar regular human
insulin regimen.
Insulin aspart was generally as effective and well tolerated as
insulin lispro when administered by continuous
subcutaneous infusion in a single comparative trial. The efficacy of
biphasic insulin aspart has been documented in a small number of trials. Both
insulin aspart and
biphasic insulin aspart provide for flexible and convenient administration.
Insulin aspart is now well established as an effective and convenient means of providing glycaemic control which offers clinical and practical advantages over regular human
insulin.