Fast-acting insulin aspart in children with diabetes type 1: efficacy of different insulin administration methods in real-world clinical practice

BACKGROUND: Fast-acting insulin aspart has superior pharmacokinetic properties compared to traditional rapid-acting insulin analogs, but data on its real-world clinical effectiveness in children and adolescents are limitedAIM: To evaluate the effectiveness of fast-acting insulin aspart compared to rapid-acting insulin analogs in children and adolescents with type 1 diabetes (T1D) under real-world clinical practice conditions.MATERIALS AND METHODS: A cross-sectional study of 2,188 children and adolescents with T1D aged 1–18 years was conducted. Primary outcomes included glycated hemoglobin (HbA1c) level and time in range (TIR, 3.9–10.0 mmol/L). Statistical analysis involved the Mann-Whitney U test for between-group comparisons and multivariate linear regression to assess independent predictors of outcomes.RESULTS: The median age of participants was 12.0 [9.0; 15.0] years, with diabetes duration of 4.3 [2.3; 7.1] years. Multivariate analysis confirmed an independent association of fast-acting insulin with 0.182% lower HbA1c (95% CI: -0.292; -0.071, p=0.001) and 2.663% higher TIR (95% CI: 1.031; 4.294, p=0.001) after adjustment for age, diabetes duration, and insulin delivery method. The most pronounced benefits were observed in adolescents aged 13–18 years and patients with diabetes duration exceeding 7 years.CONCLUSION: Fast-acting insulin aspart demonstrates statistically significant and clinically relevant advantages in glycemic control among children and adolescents with T1D in real-world clinical practice, supporting its broader use in pediatric populations.