A comparison of postprandial and preprandial administration of insulin aspart in children and adolescents with type 1 diabetes.
OBJECTIVE
The aim of this study was to compare the glycemic control of preprandial versus postprandial injections of the new rapid-acting insulin analogue aspart in children and adolescents with type 1 diabetes.


METHODS
Forty-two children (aged 6-12 years) and 34 adolescents (13-17 years) were randomized to preprandial (immediately before meal start) and postprandial (immediately after a meal or a maximum of 30 min after meal start) treatment with insulin aspart (at least thrice daily) as part of a basal/bolus regimen in a multicenter study with an open labeled, two-period cross-over design (6-week periods). Of this group, 49% were boys, 55% were aged <or=13 years, and duration of diabetes was 4.4 years (range 1.0-9.4).


RESULTS
Glycemic control for postprandial treatment was not worse than preprandial treatment as assessed by fructosamine week 0 vs. 6 (mean +/- SD, preprandial 367 +/- 74 vs. 378 +/- 90 micro mol/l; postprandial 383 +/- 83 vs. 385 +/- 77 micro mol/l) and HbA(1c) (preprandial 7.9 +/- 1.3 vs. 8.0 +/- 1.5%; postprandial 8.0 +/- 1.4 vs. 8.3 +/- 1.5%, P = 0.14). The only statistically significant finding from the seven-point blood glucose profiles and derived parameters between preprandial and postprandial treatment was a lower postprandial glucose level 120 min after breakfast (mean +/- SEM, -2.08 +/- 0.74 mmol/l, P = 0.016). The relative risk of hypoglycemia (blood glucose <3.9 mmol/l) preprandially to postprandially was not significantly different (mean 1.1; 95% CI 0.91-1.35; P = 0.31). Overall treatment satisfaction was equally high for both regimens with both patients and parents.


CONCLUSIONS
Although preprandial administration of insulin aspart is generally preferable, this study shows that in children and adolescents, postprandial administration of insulin aspart is a safe and effective alternative.
Danne
Thomas
T
Kinderkrankenhaus auf der Bult, Diabetes-Zentrum für Kinder und Jugendliche, Hannover, Germany. danne@hka.de
Aman
Jan
J
Schober
Edith
E
Deiss
Dorothee
D
Jacobsen
Judith L
JL
Friberg
Hans Henrik
HH
Jensen
Lars Hein
LH
D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects; D002648:Child; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D061267:Insulin Aspart; D008297:Male; D019518:Postprandial Period; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart