Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials
BackgroundUltra-rapid-acting insulin (URAI) improves glycemic control by reducing variability; however, optimal strategies for its use, especially within hybrid closed-loop (HCL) insulin delivery systems, remain unclear. This meta-analysis assesses the efficacy and safety of combining URAI with HCL...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1600157/full |
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| author | Mohamed Saad Rakab Rahma Mogahed Rateb Basel Hatem Elsalakawi Bashar M. Al Zoubi Abubakar Nazir Mutaz Moath Abu-Laila Abdelrahman Sherif Ghanem Alaa Maamoun Mohab Mattar Basma Ataallah Brian T. Layden Brian T. Layden Abeer M. Mahmoud Abeer M. Mahmoud |
| author_facet | Mohamed Saad Rakab Rahma Mogahed Rateb Basel Hatem Elsalakawi Bashar M. Al Zoubi Abubakar Nazir Mutaz Moath Abu-Laila Abdelrahman Sherif Ghanem Alaa Maamoun Mohab Mattar Basma Ataallah Brian T. Layden Brian T. Layden Abeer M. Mahmoud Abeer M. Mahmoud |
| author_sort | Mohamed Saad Rakab |
| collection | DOAJ |
| description | BackgroundUltra-rapid-acting insulin (URAI) improves glycemic control by reducing variability; however, optimal strategies for its use, especially within hybrid closed-loop (HCL) insulin delivery systems, remain unclear. This meta-analysis assesses the efficacy and safety of combining URAI with HCL systems in maintaining the euglycemic range and reducing glycemic excursions.MethodsWe systematically searched PubMed, Scopus, Cochrane Library, Web of Science, and related article citations for relevant studies. Outcomes assessed included time in range (TIR), time below range (TBR), and time above range (TAR) during overall 24-hour periods, daytime, nighttime, postprandial, and post-exercise periods, as well as adverse events. Dichotomous outcomes were summarized using risk ratios (RR), and continuous outcomes were pooled using mean differences (MD) presented with 95% confidence intervals (CI).ResultsURAI showed a modest, statistically non-significant improvement in TIR (70–180 mg/dL) compared to standard insulin (MD 0.87%, 95% CI [-0.21 to 1.85], P = 0.12). Importantly, glycemic variability significantly improved with URAI, as demonstrated by reductions in the coefficient of variation (CV) (MD -0.78%, 95% CI [-1.44 to -0.12], P = 0.02). The combination of URAI with HCL systems significantly reduced hypoglycemia (TBR <70 mg/dL: MD -0.32%, 95% CI [-0.56 to -0.13], P = 0.002). However, overall reductions in TAR >250 mg/dL and TAR >180 mg/dL were statistically non-significant.ConclusionThe integration of URAI with HCL demonstrates encouraging improvements in glycemic outcomes, notably reduced glucose variability and nighttime hypoglycemia risk. However, further research with larger sample sizes is essential to confirm these benefits and establish broader clinical recommendations.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024594375, identifier CRD42024594375. |
| format | Article |
| id | doaj-art-fa704e32ba0e4eb39ccf6e9963c5c3da |
| institution | OA Journals |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-fa704e32ba0e4eb39ccf6e9963c5c3da2025-08-20T02:03:16ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-06-011610.3389/fendo.2025.16001571600157Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trialsMohamed Saad Rakab0Rahma Mogahed Rateb1Basel Hatem Elsalakawi2Bashar M. Al Zoubi3Abubakar Nazir4Mutaz Moath Abu-Laila5Abdelrahman Sherif Ghanem6Alaa Maamoun7Mohab Mattar8Basma Ataallah9Brian T. Layden10Brian T. Layden11Abeer M. Mahmoud12Abeer M. Mahmoud13Faculty of Medicine, Mansoura University, Mansoura, EgyptFaculty of Medicine, Assiut University, Assiut, EgyptFaculty of Medicine, Mansoura University, Mansoura, EgyptFaculty of Medicine, Hashemite University, Zarqa, JordanCollege of Medicine, King Edward Medical University, Lahore, PakistanFaculty of Medicine, Yarmouk University, Irbid, JordanFaculty of Medicine, Mansoura University, Mansoura, EgyptFaculty of Medicine, Mansoura University, Mansoura, EgyptFaculty of Medicine, Zagazig University, Zagazig, EgyptDepartment of Medicine, Houston Methodist/Willowbrook Hospital, Houston, TX, United StatesDepartment of Medicine, Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois Chicago, Chicago, IL, United StatesDepartment of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United StatesDepartment of Medicine, Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois Chicago, Chicago, IL, United States0Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United StatesBackgroundUltra-rapid-acting insulin (URAI) improves glycemic control by reducing variability; however, optimal strategies for its use, especially within hybrid closed-loop (HCL) insulin delivery systems, remain unclear. This meta-analysis assesses the efficacy and safety of combining URAI with HCL systems in maintaining the euglycemic range and reducing glycemic excursions.MethodsWe systematically searched PubMed, Scopus, Cochrane Library, Web of Science, and related article citations for relevant studies. Outcomes assessed included time in range (TIR), time below range (TBR), and time above range (TAR) during overall 24-hour periods, daytime, nighttime, postprandial, and post-exercise periods, as well as adverse events. Dichotomous outcomes were summarized using risk ratios (RR), and continuous outcomes were pooled using mean differences (MD) presented with 95% confidence intervals (CI).ResultsURAI showed a modest, statistically non-significant improvement in TIR (70–180 mg/dL) compared to standard insulin (MD 0.87%, 95% CI [-0.21 to 1.85], P = 0.12). Importantly, glycemic variability significantly improved with URAI, as demonstrated by reductions in the coefficient of variation (CV) (MD -0.78%, 95% CI [-1.44 to -0.12], P = 0.02). The combination of URAI with HCL systems significantly reduced hypoglycemia (TBR <70 mg/dL: MD -0.32%, 95% CI [-0.56 to -0.13], P = 0.002). However, overall reductions in TAR >250 mg/dL and TAR >180 mg/dL were statistically non-significant.ConclusionThe integration of URAI with HCL demonstrates encouraging improvements in glycemic outcomes, notably reduced glucose variability and nighttime hypoglycemia risk. However, further research with larger sample sizes is essential to confirm these benefits and establish broader clinical recommendations.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024594375, identifier CRD42024594375.https://www.frontiersin.org/articles/10.3389/fendo.2025.1600157/fullclosed-loop systemsultra fast acting insulin analogstype 1 diabetesglucose variabilitymeta-analysis |
| spellingShingle | Mohamed Saad Rakab Rahma Mogahed Rateb Basel Hatem Elsalakawi Bashar M. Al Zoubi Abubakar Nazir Mutaz Moath Abu-Laila Abdelrahman Sherif Ghanem Alaa Maamoun Mohab Mattar Basma Ataallah Brian T. Layden Brian T. Layden Abeer M. Mahmoud Abeer M. Mahmoud Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials Frontiers in Endocrinology closed-loop systems ultra fast acting insulin analogs type 1 diabetes glucose variability meta-analysis |
| title | Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials |
| title_full | Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials |
| title_fullStr | Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials |
| title_full_unstemmed | Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials |
| title_short | Ultra-rapid lispro or fast-acting aspart compared to standard insulin lispro and aspart using closed-loop insulin therapy: a systematic review and meta-analysis of randomized control trials |
| title_sort | ultra rapid lispro or fast acting aspart compared to standard insulin lispro and aspart using closed loop insulin therapy a systematic review and meta analysis of randomized control trials |
| topic | closed-loop systems ultra fast acting insulin analogs type 1 diabetes glucose variability meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1600157/full |
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