Mealtime fast‐acting insulin aspart versus insulin aspart for controlling postprandial hyperglycaemia in people with insulin‐resistant Type 2 diabetes

AIM: This post hoc analysis explored whether mealtime fast‐acting insulin aspart treatment provided an advantage in postprandial plasma glucose (PPG) control vs. insulin aspart in people with Type 2 diabetes receiving high doses of bolus insulin. METHODS: A post hoc, post‐randomization, subgroup analysis of a 26‐week, randomized, double‐blind, treat‐to‐target trial (onset 2) that compared mealtime fast‐acting insulin aspart vs. mealtime insulin aspart, both in a basal–bolus regimen, in people with Type 2 diabetes uncontrolled on basal insulin therapy and metformin. At the end of trial, the impact of fast‐acting insulin aspart and insulin aspart on PPG control was assessed with a standard liquid meal test and participants were grouped into three post‐randomization subgroups: meal test bolus insulin dose ≤ 10 units per dose (n = 171), > 10–20 units per dose (n = 289) and > 20 units per dose (n = 146). RESULTS: A statistically significant treatment difference in favour of fast‐acting insulin aspart vs. insulin aspart was observed for the change in PPG increment at all post‐meal time points (from 1 to 4 h) for those in the > 20 units bolus insulin subgroup. There was no difference in the magnitude of change from baseline in HbA(1c) level between fast‐acting insulin aspart and insulin aspart in any of the bolus insulin dose subgroups (data herein). CONCLUSION: Fast‐acting insulin aspart may hold promise as a more effective treatment compared with insulin aspart for controlling PPG in people with insulin‐resistant Type 2 diabetes.