We investigated which ultra-rapid acting insulin (URI) is the most effective in improving glycemic variability (GV)- insulin glulisine (G), insulin lispro (L) or insulin aspart (A). We calculated a required sample size of 12. Thirty type 2 diabetic patients were randomly allocated to 3 groups. On admission, preprandial and bedtime glucose levels (PB)(GL) were stabilized at 80 mg/dL level with URI (before wearing continuous glucose monitoring (FreeStyle Libre Pro) device (FLP); G) and insulin glargine 300 U/ml (G300) during the study period. Group 1: PBGL were stabilized; next, the same dose G was taken, patients wore a FLP and GV was evaluated on days 3 and 4; G was then switched to the same dose L, and GV was evaluated on days 8 and 9; finally, L was switched to the same dose A and GV was evaluated on days 13 and 14. Group 2: URI was taken in the order of L, A, G, following the same regimen. Group 3, URI was taken in the order of A, G, and L, following the same regimen. URI was administered at 08:00, 12:00, 18:00. G300 was administered at 08:00. Data collected on the second evaluation day were analysed. Test meals were given. Increased postprandial (Po) GL, Po glucose gradients, area over the glucose curve (<70 mg/dL) were significantly lower in patients on G, L, A, in that order. Start time of hypoglycemia occurrences (HO) was significantly earlier and finish time of HO was significantly later in patients on A than L. G is the best URI to improve GV.
S. Takeishi: None. H. Tsuboi: None. S. Takekoshi: None.
