title: Post-prandial administration of the insulin analogue insulin aspart in patients with Type 1 diabetes mellitus.
abstract: OBJECTIVE
  In intensified insulin therapy, the recent development of short-acting insulin analogues with a very rapid onset of action forces a new discussion in terms of the optimal injection-meal interval. This study evaluated prandial glycaemia in patients with Type 1 diabetes following the subcutaneous injection of soluble human insulin (HI) and the insulin analogue insulin aspart (IAsp) at different injection-meal intervals and investigated whether administration of IAsp after the meal might provide satisfactory metabolic control.
  
  
  METHODS
  In a randomized, double-blind, double-dummy, four-period crossover study, 20 Type 1 diabetic patients were investigated. Prandial insulin was administered 15 min before the start of the meal (HI(-15min)), immediately before the meal (HI(0min); IAsp(0min)) and 15 min after the start of the meal (IAsp(+15min)).
  
  
  RESULTS
  Plasma glucose excursions from baseline levels during the 4 h (PGexc) were highest with HI(0min) (17.9 mmol.l(-1).h; P < 0.05 vs. other treatments) and were not statistically different for HI(-15min), IAsp(0min) and IAsp(15min) (13.6, 11.9 and 14.2 mmol.l(-1).h, respectively). Maximum concentration of plasma glucose (PGmax) was lowest with IAsp(0min) (11.2 mmol/l; P < 0.05 vs. other treatments). PGmax was comparable with HI(-15min), HI(0min) and IAsp(+15min) (13.3, 14.1 and 13.2 mmol/l, respectively).
  
  
  CONCLUSIONS
  With regard to prandial glycaemia IAsp(+15min) is as effective as HI(-5min) and superior to HI(0min). Thus, post-prandial dosing of the insulin analogue IAsp offers an attractive and feasible therapeutic option for well-controlled patients with Type 1 diabetes mellitus.
authors.affiliation: Department of Internal Medicine, Karl-Franzens University, Graz, Austria. gernot.brunner@kfunigraz.ac.at
authors.forename: G A
authors.initials: GA
authors.lastname: Brunner
authors.forename: S
authors.initials: S
authors.lastname: Hirschberger
authors.forename: G
authors.initials: G
authors.lastname: Sendlhofer
authors.forename: A
authors.initials: A
authors.lastname: Wutte
authors.forename: M
authors.initials: M
authors.lastname: Ellmerer
authors.forename: B
authors.initials: B
authors.lastname: Balent
authors.forename: L
authors.initials: L
authors.lastname: Schaupp
authors.forename: G J
authors.initials: GJ
authors.lastname: Krejs
authors.forename: T R
authors.initials: TR
authors.lastname: Pieber
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005502:Food; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use; D061267:Insulin Aspart; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart