The impact of baseline HbA1c on the efficacy and safety of fast-acting insulin aspart (FA) was assessed in a post-hoc analysis of a 16-week, treat-to-target trial in adults with type 2 diabetes (T2D) not optimally controlled with a basal-bolus regimen (onset 9). Participants (n=1091) were randomized to FA or insulin aspart (IAsp), each with insulin degludec with or without metformin. In this analysis, participants were separated by baseline HbA1c (<7.0%, [n=476] and ≥7.0% [n=615]).

Change from baseline in HbA1c was similar between treatments in the <7.0% subgroup, and HbA1c improved with FA vs. IAsp in the ≥7.0% subgroup (Table). Change from baseline in 1-h postprandial glucose (PPG) increment (meal test) favored FA across subgroups. The rate of severe or blood glucose-confirmed hypoglycemia was statistically significantly lower for FA vs. IAsp in the <7.0% subgroup, and was similar between treatments in the ≥7.0% subgroup. In the ≥7.0% subgroup treated with IAsp, the insulin degludec dose decreased slightly during the trial.

FA provides effective overall glycemic control with improved PPG control vs. IAsp in adults with T2D. For individuals with HbA1c <7.0%, FA provides a similar reduction in HbA1c vs. IAsp, but with less hypoglycemia. For individuals with HbA1c ≥7.0%, FA may offer a greater reduction in HbA1c vs. IAsp without an increased risk of hypoglycemia.


E. Franek: Advisory Panel; Self; Novartis AG. Speaker’s Bureau; Self; AstraZeneca, Bioton, Eli Lilly and Company. Other Relationship; Self; Boehringer Ingelheim, Novo Nordisk. M. Ekelund: Employee; Self; Novo Nordisk. Stock/Shareholder; Self; Novo Nordisk. Stock/Shareholder; Spouse/Partner; Novo Nordisk. Ó. Thórisdóttir: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. H. Jang: Speaker’s Bureau; Self; Daiichi Sankyo, Handok, Pfizer Inc., Takeda Pharmaceutical Company Limited. K. Lalic: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim, Merck, Novo Nordisk, Sanofi. N. Rathor: Employee; Self; Novo Nordisk. L. Rose: None. A. Soto Gonzalez: Advisory Panel; Self; Novartis, Novo Nordisk. Consultant; Self; Mundipharma International, Novartis, Novo Nordisk. Speaker’s Bureau; Self; Eli Lilly and Company, Janssen/Mundipharma, Novartis, Novo Nordisk, Sanofi. R.J. Silver: Advisory Panel; Self; Medtronic, Novo Nordisk. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk. W. Lane: Research Support; Self; AstraZeneca, Gilead, Mylan, Sanofi, Tolerion, vTv. Other Relationship; Self; Dexcom, Insulet, Novo Nordisk.


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