FDA Approves First Insulin Analog for Use in Insulin Pumps by Children, Adolescents

The FDA has approved insulin aspart (rDNA origin) injection (NovoLog) for continuous subcutaneous insulin infusion (CSII) by external insulin pump in pediatric patients aged 4 to 18 years. It is the first and only insulin analog approved for this use Data from a trial demonstrated that insulin aspart injection achieved similar levels of glycemic control and safety compared with insulin lispro CSII.

The study results came from a 16-week, open-label, multicentre, parallel group trial of 298 patients (aspart, n = 198; lispro, n = 100) who were aged 4 to 18 years; had type 1 diabetes for 1 year or more; whose CSII therapy treatment lasted 3 months or longer; and had A1C less than or equal to 10% at screening.

Patients were randomized 2:1 to insulin aspart injection CSII or insulin lispro CSII via an external pump, with changes in reservoir, infusion set, and infusion site at least once every 48 hours. Patients were stratified by age (ie, 3-5 y, 6-11 y, 12-18 y) before randomisation.

At the conclusion of the study, both treatments resulted in comparable changes in baseline A1C. Nearly 60% of the participants given insulin aspart injection achieved age-specific A1C goals — defined by the American Diabetes Association as <8.5% for subjects aged <6 years and <8% for subjects aged 6 to 18 years — compared with 43.8% of patients given insulin lispro.

In addition, the weight-adjusted mean daily dose of insulin aspart injection was significantly less than insulin lispro (0.86 unit/kg vs 0.94 unit/kg; P = 0.018). Rates of hypoglycemia and numbers and types of adverse events were similar between both treatment groups.

"[Insulin aspart injection] CSII was shown to be safe and tolerable in paediatric subjects between the ages of 4 and 18 years old," said lead study author Stuart A. Weinzimer, MD, Associate Professor, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. "The results of this study confirm that [insulin aspart injection] CSII therapy is efficacious in appropriately selected children and adolescents."

Diabetes Care, February 2008
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DID YOU KNOW:
Antidepressant use, progression to diabetes linked: Patients who take antidepressant medications may be at increased risk for developing diabetes, according to results of a new study. Richard R. Rubin, PhD, professor of medicine and pediatrics at the Johns Hopkins University assessed the association between antidepressant use and diabetes in individuals at high risk for the disease. They evaluated 3,187 participants enrolled in one of three treatment arms in the Diabetes Prevention Program: intensive lifestyle, metformin and placebo. Researchers from various sites in the United States followed the participants for an average of 3.2 years and found that elevated depression scores consistent with mild depression at baseline and during the study were not associated with progression to diabetes in any of the three treatment arms. However, antidepressant use at baseline was associated with increased diabetes risk in both the placebo arm and intensive lifestyle arm (HR=3.48). Participants who took antidepressants on a continuous basis during the study were also at increased risk for diabetes. Intermittent use was associated with diabetes risk only in the intensive lifestyle arm.

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