Comparison of the efficiency of different rapid-acting insulin analogues used in continuous subcutaneous insulin infusion in the glycaemic control of children with Type 1 Diabetes

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Introdução: O uso de análogos de insulina de ação rápida em perfusão subcutânea contínua de insulina como tratamento da diabetes mellitus tipo 1 é considerado eficaz na melhoria do controlo glicémico e na diminuição do risco de hipoglicemia.Atualmente, os análogos disponíveis incluem aspártico (Novorapid ® ), lispro (Humalog ® ), glulisina (Apidra ® ), e um novo análogo de insulina de ação ultrarrápida, faster insulin aspart (Fiasp ® ).Introduction: The use of rapid-acting insulin analogues in continuous subcutaneous insulin infusion as a treatment for type 1 diabetes is considered effective in improving glycaemic control and decreasing the risk of hypoglycaemia.Currently, the available analogues include aspart (Novorapid ® ), lispro (Humalog ® ) and glulisine (Apidra ® ), as well as a new ultra-rapid insulin analogue, faster insulin aspart (Fiasp ® ).Objective was to compare the impact of different rapid-acting insulin analogues (Novorapid ® , Humalog ® , Apidra ® and Fiasp ® ) used in continuous subcutaneous insulin infusion in the glycaemic control of children diagnosed with type 1 diabetes.Methods: Retrospective study including 98 patients diagnosed with type 1 diabetes at age 10 or younger under continuous subcutaneous insulin infusion treatment at Hospital de Braga's Outpatient Paediatric Endocrinology continuous subcutaneous insulin infusion Center.Results: Regarding the HbA1c values at 3 months, 6 months and 5 years after initiation of continuous subcutaneous insulin infusion, no statistically significant differences were observed between different insulin analogues used (p=0.396,p=0.155 and p=0.518, respectively).The HbA1c values obtained at 12 months and 2 years were significantly higher in Humalog ® compared to Fiasp ® (p=0.036 and p=0.019, respectively).At 3 years, the HbA1c value of patients with Humalog ® was significantly higher than that of patients with Apidra ® (p=0.019).The follow-up time for patients with Novorapid ® was significantly longer than for those with Apidra ® and Fiasp ® (respectively, p=0.001 and p=0.023).Conclusion: Novorapid ® , Humalog ® and Apidra ® have similar efficiency in the glycaemic control of children with type 1 diabetes using continuous subcutaneous insulin infusion.Fiasp ® may have benefit in the glycaemic control of these children, when compared with Humalog ® .However, it is necessary to conduct further studies, in paediatric age, on the use of this insulin in continuous subcutaneous insulin infusion.

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