Ultrafast-acting insulin: pharmacological properties and their impact on clinical aspects

The goal of modern insulin therapy used in the treatment of diabetes mellitus is to mimic physiologic insulin secretion by pancreatic beta cells. The new ultrafast-acting insulin analog aspart (UFAiAsp) demonstrates a faster onset and shorter duration of action compared to the ultra-short-acting insulin analog aspart (USAIasp), which substantiates the possibility of insulin administration immediately before meals, which helps to improve glycemic control by regulating postprandial glucose levels, improving patients' quality of life. We conducted a literature search for the period from 2012 to 2023 in the electronic databases PubMed, Elibrary.ru, and Cophrane library of scientific information on the efficacy and safety of ultrafast-acting insulin aspart in comparison with USAIasp. With the use of UFAiAsp, a reduced risk of late postprandial hypoglycemia due to increased absorption rate and earlier termination of the sugar-lowering effect was observed. The problem of using ultrafast-acting insulin aspart in our country, which is solved by the admission of biosimilar drugs (biosimilars) to the market, is considered. It was shown that the domestically produced biosimilar UFAiAsp (RinFast® Nick) registered in the Russian Federation is recognized as interchangeable with the original UFAiAsp (Fiasp®) in terms of bio- and therapeutic equivalence, immune safety, good tolerability, and also meets the specification norms when used for continuous subcutaneous infusion in terms of physicochemical parameters. Dosing accuracy and absence of occlusions in the systems over 72 hours with the new biosimilar in pumps have been proven. Consequently, UFAiAsp can be recommended for all patients, including children, who require the prandial component of insulin therapy.