Latest research on Aspart

Insulin aspart is a recombinant, biosynthetic, fast-acting insulin analogue. It has a single amino acid substitution at position B28 where proline is replaced with aspartic acid. This substitution decreases its propensity to form hexamers and gives it a higher rate of absorption following subcutaneous administration compared to native insulin. Insulin aspart is produced in a genetically modified strain of _Saccharomyces cerevisiae_ and harvested from a bioreactor.

Aspart dosage

The patient’s daily insulin dose has been progressively increased to a regimen of glargine 115 units twice a day and Aspart 45–60 units prior to each meal. [source, 2016]
This was an open-label, treat-to-target, non-inferiority trial comparing insulin degludec (100 U/mL) in a fixed schedule (with minimum 8 h and maximum 40 h between doses) with degludec (100 U/mL; 3 mL) or glargine (100 U/mL; 3 mL) given at the same time every day, once daily, with mealtime insulin Aspart. [source, 2016]
Physicians would order insulin glargine (Lantus) vials and insulin Aspart (NovoLog) flexpens without specifying doses. [source, 2015]
Inclusion criteria were: (1) admission or transfer to a participating floor in the 3 days prior to screening (to accommodate the lack of screening on weekends); (2) age ≥18 years; (3) diagnosis of type-1 or 2 diabetes mellitus; (4) a home basal-bolus insulin regimen administered via subcutaneous injection rather than pump; (5) willingness to use specified basal-bolus insulins (Aspart pen and glargine vial); (6) most recent glycosylated hemoglobin of <7.5 % (<58 mmol/mol) measured in the 180 days prior to the current hospitalization; (7) active order for basal-bolus or sliding scale insulin; (8) willingness to document self-measured blood glucose results, self-administered insulin doses, food intake, and physical activity; and (9) approval from the clinical team. [source, 2015]
Both studies showed comparable HbA1c reduction, with superior reduction in fasting plasma glucose for IDegAsp (ETD −1.06 mmol/L [−1.43, −0.70], P<0.001 in the Kaneko et al trial23 and −1.14 mmol/L [−1.53, −0.76], P<0.001) in the Fulcher et al trial24 with a lower total daily insulin dose in IDegAsp versus biphasic insulin Aspart 30. [source, 2015]
Within five months he was using 158 units per day of detemir, in divided doses, plus insulin Aspart 24 units with each meal. [source, 2015]
Basal insulin was then changed to insulatard 70 units per day in divided doses (insulin Aspart dose unchanged) and within four months his HbA1c had fallen to 51 mmol/mol (6.8%) and by 12 months he had lost 6 kg of weight. [source, 2015]
At the time of referral the detemir dose was 120 units twice daily and NovoRapid 120 units with each meal (total of 600 units/day). [source, 2015]
After six months, the dose of insulatard had stabilized at 140 units BD and NovoRapid 50 units TDS (430 units/day – 30% reduction in total daily dose), his weight remained unchanged and despite the reduction in insulin dose, HbA1c improved to 50 mmol/mol (6.7%). [source, 2015]
A combination therapy could be a fixed-dose combination or more than one single agent that were used with an overlap of at least 30 days, except for a fixed-dose combination of insulin (eg, short-term act Aspart and long-term act protamine together), which was considered insulin monotherapy. [source, 2015]