Description:
<jats:p>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.</jats:p>
<jats:p>RESEARCH DESIGN AND 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 ≤13 years, and duration of diabetes was 4.4 years (range 1.0–9.4).</jats:p>
<jats:p>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 μmol/l; postprandial 383 ± 83 vs. 385 ± 77 μmol/l) and HbA1c (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 &lt;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.</jats:p>
<jats:p>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.</jats:p>