What is Type 1 Diabetes Mellitus (T1DM), an insulin-dependent condition?

From the Guidelines

Type 1 diabetes mellitus should be treated with multiple-dose insulin injections or continuous subcutaneous insulin injection, with a focus on intensive insulin therapy to reduce the risk of microvascular complications and cardiovascular disease. The American Diabetes Association recommends that most patients with type 1 diabetes should use insulin analogues to reduce hypoglycemia risk 1.

Key Components of Treatment

• Multiple-dose insulin injections or continuous subcutaneous insulin injection should be used to achieve optimal glycemic control 1
• Intensive insulin therapy, with at least 3 injections of insulin per day, is recommended to reduce the risk of microvascular complications and cardiovascular disease 1
• Insulin analogues should be used to reduce hypoglycemia risk 1
• Patients should be educated on matching prandial insulin doses to carbohydrate intake, preprandial blood glucose levels, and anticipated activity level 1
• Continuous glucose monitoring systems can be used to reduce severe hypoglycemia risk in patients with type 1 diabetes 1

Lifestyle Modifications

• A physical activity plan should include at least 150 minutes of moderate-intensity aerobic activity per week, reduced sedentary time, and resistance training at least twice per week for most adults with diabetes 1
• Patients should work with a dietitian to develop a personalized meal plan that takes into account their individual needs and lifestyle 1

Monitoring and Follow-up

• Blood glucose monitoring is essential, with target ranges of 80-130 mg/dL before meals and under 180 mg/dL after meals
• Regular medical follow-up is necessary, with HbA1c testing every 3-6 months, aiming for levels below 7%
• Patients should be educated on hypoglycemia management, sick day rules, and lifestyle factors to improve their overall quality of life 1

From the FDA Drug Label

The efficacy of insulin aspart to improve glycemic control in pediatric patients with type 1 diabetes mellitus is based on an adequate and well-controlled trial of regular human insulin in pediatric patients with type 1 diabetes mellitus The safety and effectiveness of subcutaneous insulin aspart were compared to regular human insulin in 596 type 1 diabetes adult, 187 pediatric type 1 diabetes, and 91 adult type 2 diabetes patients using NPH as basal insulin Two 24-week, open-label, active-controlled studies were conducted to compare the safety and efficacy of insulin aspart to regular human insulin injection in adult patients with type 1 diabetes The reduction in glycated hemoglobin (HbA1c) was similar to regular human insulin.

Insulin Aspart is effective in improving glycemic control in patients with Type 1 Diabetes Mellitus, as shown by similar reductions in HbA1c compared to regular human insulin in clinical studies 2.

• Key findings include:
  • Similar effects on HbA1c in adult and pediatric patients with Type 1 Diabetes Mellitus
  • Comparable changes in HbA1c between insulin aspart and regular human insulin in clinical studies
• Clinical studies demonstrated the safety and efficacy of subcutaneous insulin aspart in patients with Type 1 Diabetes Mellitus, including adult and pediatric populations 2.

From the Research

Type 1 Insulin Dependent Diabetes Mellitus

• Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by hyperglycemia, impaired metabolism and storage of important nutrients, evidence of autoimmunity, and long-term vascular and neurologic complications 3.
• The goal of treatment is to relieve symptoms and to achieve blood glucose levels as close to normal as possible without severe hypoglycemia 3.
• Insulin is the primary treatment in all patients with T1DM, typically requiring initiation with multiple daily injections at the time of diagnosis 4.
• Rapid-acting insulin analogues provide better and safer postprandial glucose coverage than does human regular insulin 5.
• Continuous infusion of soluble insulin by means of an insulin pump is currently the most physiologic approach available for treatment of T1DM 5.
• Use of insulin glargine or insulin detemir with a rapid-acting insulin analogue at meals is an effective and reasonable alternative to insulin pump therapy 5, 6.

Insulin Regimens

• Most patients with T1DM should follow a regimen of multiple daily injections of basal/bolus insulin 7.
• Basal insulin analogues with a reduced peak profile and an extended duration of action with lower intraindividual variability relative to neutral protamine Hagedorn insulin are preferred 7.
• For prandial glycemic control, any rapid-acting prandial analogue (aspart, glulisine, lispro) is preferred over regular human insulin 7, 6.
• Frequent blood glucose measurements along with patient education on insulin dosing based on carbohydrate counting, premeal blood glucose, and anticipated physical activity is paramount 7.

Glycemic Targets

• A glycemic target of glycated hemoglobin < 7% (53 mmol/mol) is appropriate for most nonpregnant adults with T1DM 7.
• The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol) 4.
• Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient's care plan 4.