Impact of Ultra-Rapid Insulin on Boost and Ease-Off in the Cambridge Hybrid Closed-Loop System for Individuals With Type 1 Diabetes.

Objective: The objective was to evaluate the safety and efficacy of ultra-rapid-acting insulin with the Boost and Ease-off features of the Cambridge hybrid closed-loop system.
Methods: A secondary analysis of Boost and Ease-off from two double-blind, randomized, crossover hybrid closed-loop studies comparing (1) Fiasp to insulin aspart (n = 25), and (2) Lyumjev to insulin lispro (n = 26) was carried out. Mean glucose on initialization of Boost and Ease-off, change in glucose 60 and 120 minutes after initialization, duration and frequency of use, mean glucose, and time in, above, and below target glucose range were calculated for periods of Boost use, Ease-off use, or neither.
Results: Participants used Boost for longer with Fiasp than insulin aspart (median [interquartile range, IQR] = 75 [53-125] minutes vs 60 [49-75] minutes; P = .01). Mean glucose on Boost initialization with Fiasp was 238 ± 62 mg/dL compared with 218 ± 45 mg/dL with insulin aspart ( P = .08). Fiasp use resulted in a greater glucose reduction 120 minutes after Boost initialization [-59 ± 34 mg/dL vs -43 ± 31 mg/dL; P = .02]. There were no statistically significant differences in sensor glucose endpoints during Boost or Ease-off periods between Fiasp and aspart. There were no statistically significant differences during Boost or Ease-off periods when comparing Lyumjev with insulin lispro. There were no safety issues when using Boost and Ease-off with ultra-rapid insulins.
Conclusions: The use of Fiasp and Lyumjev during Boost or Ease-off resulted in comparable safety and efficacy to using insulin aspart and lispro.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CB is a consultant at CamDiab and has received speaker honoraria from Ypsomed. MN has received travel grant support from Sanofi, Janssen, and Eli Lilly and was previously chair of the Young Diabetologists’ and Endocrinologists’ Forum in the United Kingdom, which uses unrestricted sponsorship from industry partners to deliver educational programs for health care professionals. SH serves as a member of Medtronic advisory board, is a director of Ask Diabetes Ltd, providing training and research support in health care settings, and reports having received training honoraria from Medtronic and Sanofi and consulting fees for CamDiab. MEW is a consultant to CamDiab and reports patents related to closed loop. JW has received speaker honoraria from Ypsomed and Novo Nordisk. HT receives consulting fees and speaker honoraria from Eli Lilly and Dexcom Inc, reports having received research support from Dexcom Inc, and participated in advisory groups for Medtronic, Abbott Diabetes Care, and Roche Diabetes Care. JKM is a member in the advisory boards of Abbott Diabetes Care, Becton-Dickinson/Embecta, Biomea, Eli Lilly, Medtronic, Novo Nordisk, Pharmasens, Roche Diabetes Care, Sanofi, and Viatris; received speaker honoraria from Abbott Diabetes Care, A. Menarini Diagnostics, Becton-Dickinson/Embecta, Boehringer-Ingelheim, Eli Lilly, MedTrust, Novo Nordisk, Roche Diabetes Care, Sanofi, and Ypsomed; and is shareholder of decide Clinical Software GmbH and elyte Diagnostics. LB reports having participated in advisory boards of Eli Lilly, Novo Nordisk, Oviva, Roche Diabetes Care, Sanofi, and Ypsomed and received speaker fees from Dexcom, Ypsomed, and Oviva. LL has received research support from Abbott Diabetes Care and Dexcom, participated in advisory groups for Abbott Diabetes Care, Insulet, Dexcom, Medtronic, and Roche Diabetes, and received fees for speaking from Sanofi, Insulet, Medtronic, and Abbott Diabetes Care. MLE has been a member of advisory panels and/or received speaker fees from Novo Nordisk, Eli Lilly, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, Ypsomed, Pila Pharma, and Zucara. RH reports having received speaker honoraria from Eli Lilly, Dexcom, and Novo Nordisk; receiving license fees from B. Braun; patents related to closed-loop; being consultant to Abbott Diabetes Care; and being director at CamDiab. CR, RL, and JMA report no conflicts of interest related to the present paper.