1. Achieving Optimal Glycaemic Control: Can Insulin Deliver?
David Russell-Jones
Thomas Danne
Andreas Liebl

2. Recommended Targets for PPG
PPG target
(1–2 hours post meal)
ADA/EASD1,2
< 10 mmol/L
< 180 mg/dL
AACE3
< 7.8 mmol/L
< 140 mg/dL
IDF4
< 9 mmol/L < 160 mg/dL
3:03
1. Inzucchi SE, et al. Diabetologia. 2015;58: ADA Guidelines. Diabetes Care. 2017;40 Suppl 1:S Garber AJ, et al. Endocr Pract. 2016;22; International Diabetes Federation. Guideline for Management of PostMeal Glucose in Diabetes. Available at: Accessed February 2017.
AACE, American Association of Clinical Endocrinologists; ADA, American Diabetes Association; EASD, European Association for the Study of Diabetes; IDF, International Diabetes Federation; PPG, postprandial glucose.

3. PPG Contributes to HbA1c1,2
FPG
HbA1c
PPG is the main contributor to HbA1c in patients near target HbA1c2
Relative to the influence of FPG, PPG is more closely associated with HbA1c control3
If FPG is at target (< 100 mg/dL), 64% of patients achieve HbA1c < 7.0%4
If PPG is at target (< 140 mg/dL), 94% of patients achieve HbA1c < 7.0%4
5:47
1. Monnier L, et al. Diabetes Care. 2007;30: Monnier L, et al. Endocr Pract. 2006;12 Suppl 1:42-6.
3. Ketema L, et al. Arch Public Health. 2015;73:43.
4. Woerle HJ, et al. Diabetes Res Clin Pract. 2007;77:280-5.
FPG, fasting plasma glucose; HbA1c, glycated haemoglobin A1c.

4. Patient Profile 1 18-year-old male
Diagnosed with type 1 diabetes 5 years ago
Using continuous glucose monitoring
Meal
Preprandial
Time (hours)
400
300
200
140 70 40
+5:00
+1:00
−1:00
Sensor glucose
(mg/dL)
6:48

5. 24-hour glucose profiles over 7 days
Patient Profile 2
58-year-old male
Diagnosed with type 2 diabetes 8 years ago
Abdominal obesity (BMI 30 kg/m2)
MI 2 years ago
Normal eating habits
Diabetes treatment
Metformin (1,000 mg b.i.d.)
Empagliflozin (10 mg once daily)
Insulin glargine (48 units at bedtime)
Insulin lispro (50 units before breakfast, 24 units before lunch and dinner)
24-hour glucose profiles over 7 days
We Aug 31
Th Sep 01
Fr Sep 02
Sa Sep 03
Su Sep 04
Mo Sep 05
Tu Sep 06 50
100
150
200
250
300
350
400
mg/dL
8:43
00:00
03:00
12:00
15:00
18:00
21:00
06:00
09:00
b.i.d., twice daily; BMI, body-mass index; MI, myocardial infarction.

6. Ultra-Fast-Acting IAsp: A New Formulation of IAsp
Niacinamide: absorption modifier
Vitamin B3
L-arginine: added for stability
13:18
IAsp
Naturally occurring amino acid
IASp, insulin aspart.
Heise T, et al. Diabetes Obes Metab. 2015;17:682-8.

7. Free IAsp concentration (pmol/L) Nominal time (minutes)
Ultra-Fast-Acting IAsp: Early Onset of Appearance and 2-Fold Higher Concentration After 30 Minutes1
Treatment:
Ultra-fast-acting IAsp
IAsp
400
AUC0–30 minutes (pmol*h/L)
AUC0–1 hours (pmol*h/L)
AUC0–2 hours (pmol*h/L)
Ultra-fast-acting IAsp/IAsp 1 2 3 4 5
Ratio [95% CI]
2.05 [1.76; 2.38]
1.28 [1.15; 1.43]
1.04 [0.95; 1.14]
300
Free IAsp concentration (pmol/L)
200
Onset of appearance: 4.9 minutes (ultra-fast-acting IAsp) vs 11.2 minutes (IAsp) Ratio 0.43 [95% CI 0.36; 0.51]
100
AUC0–12 hours (pmol*h/L)
0.96 [0.87; 1.06]
14:59 30 60 90
120
Nominal time (minutes)
Consistent pharmacokinetic profile in children,2 adolescents,2 adults,2 and elderly3
1. Heise T, et al. Diabetes Obes Metab. 2015;17:682-8.
2. Danne T, et al. Diabetes. 2015;64 Suppl 1:A247 (abstract 976-P).
3. Heise T, et al. Drugs Aging. 2017;34:29-38.
AUC, area under the curve; CI, confidence interval.

8. Early Glucose-Lowering Effects
AUC0–30 minutes (mg/kg)
AUC0–1 hour (mg/kg)
AUC0–2 hours (mg/kg)
Ultra-fast-acting IAsp/IAsp 1 2 3 4 5
Ratio [95% CI]
1.48 [1.13; 2.02]
1.31 [1.18; 1.46]
1.10 [1.00; 1.22]
AUC0–12 hours (mg/kg)
0.98 [0.87; 1.11]
15:48
Ultra-fast-acting IAsp provided a 1.5-fold greater early glucose-lowering effect compared with IAsp, while maintaining a similar total glucose-lowering effect
Heise T, et al. Diabetes Obes Metab. 2015;17:682-8.

9. PPH was a significant predictor of cardiovascular events and mortality
Impact of PPH
For patients, PPH can affect mood and cognitive function1
PPH is also associated with:
Microvascular complications2,3
Cardiovascular events4
Cardiovascular5 and all-cause mortality4,5
San Luigi Gonzaga diabetes study: 14-year follow-up of 505 patients with type 2 diabetes4
Outcome
HR [95% CI]; p value
Cardiovascular events
1.452 [1.057; 1.994]; 0.021
All-cause mortality
1.846 [1.306; 2.610]; 0.001
18:15
PPH was a significant predictor of cardiovascular events and mortality
1. Sommerfield AJ, et al. Diabetes Care. 2004;27:
2. Shichiri M, et al. Diabetes Care. 2000;23 Suppl 2:B21-9.
3. UKPDS Group. Lancet. 1998;352:
4. Cavalot F, et al. Diabetes Care. 2011;34:
5. DECODE Study Group. Arch Intern Med. 2001;161:
PPH, postprandial hyperglycaemia.

10. Impact of Ultra-Fast-Acting Insulin Analogues and Future Challenges
Ultra-fast-acting insulin analogues support intensive insulin therapy strategies for patients with diabetes1,2
Convenience and flexibility of ultra-fast-acting insulin analogues may help reduce glycaemic variability1–3
Future challenges include integrating ultra-fast-acting insulin analogues into strategies utilizing new technologies, such as closed-loop systems4
20:46
1. Bowering K, et al. Diabetes. 2016;65 Suppl 1:A63 (abstract 240-OR).
2. Russell-Jones D, et al. Diabetes. 2016;65 Suppl 1:A77 (abstract 293-OR).
3. Heise T, et al. Diabetes Obes Metab. 2015;17:682-8.
4. Kowalski A. Diabetes Care. 2015;38: