Impact of insulins glulisine and aspart on postprandial glycemia after a high-glycemic index meal in children with type 1 diabetes

Objective: According to current knowledge, glulisine insulin (GLU) has a slightly faster onset of action than aspart ( ASP) insulin. Therefore, GLU might lead to a better postprandial profile than ASP following the consumption of high-glycemic index (H-GI) meals. The aim of this study was to assess differences in the action of GLU and ASP after the consumption of a H-GI meal in type 1 diabetic children treated with insulin pumps. Design: Fifty-six type 1 diabetic children of mean age 14.7 +/- 2.0 years were included in a randomized, double-blind, two-way crossover study. The subjects were allocated to one of two treatment orders: GLU-ASP and ASP-GLU. They were given a H-GI breakfast for two subsequent days. Methods: The primary outcome was postprandial glycemia (PPG) based on continuous glucose monitoring system and self monitoring of blood glucose levels during 3 h of follow-up. The secondary outcomes were the frequency of hypoglycemia, glucose area under the curve, mean amplitude of glycemic excursion, and glycemic rise. Results: There were no significant differences between the groups with regard to PPG in the determined time intervals as well as with respect to the secondary outcomes. Between 60 and 120 min after food consumption in both study groups, blood glucose levels were close to or above 10.0 mmol/ l. Glucose peaks were higher in the GLU-ASP group than in the ASP-GLU group ( 90 min: P=0.065; 120 min: P=0.052). Most of the episodes of hypoglycemia were observed after the second hour of follow-up. Conclusions: No statistically significant difference was found between GLU and ASP with regard to PPG after the consumption of a H-GI breakfast. Neither GLU nor ASP stabilized the glycemic profile after the consumption of a H-GI