OBJECTIVE -The aim of this study was to compare the glycemic control of preprandial versus postprandial injections of the new rapid-acting insulin analogue aspart in children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS -Forty-two children (aged 6 -12 years) and 34 adolescents (13-17 years) were randomized to preprandial (immediately before meal start) and postprandial (immediately after a meal or a maximum of 30 min after meal start) treatment with insulin aspart (at least

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... thrice daily) as part of a basal/bolus regimen in a multicenter study with an open labeled, two-period cross-over design (6-week periods). Of this group, 49% were boys, 55% were aged Յ13 years, and duration of diabetes was 4.4 years (range 1.0 -9.4). RESULTS -Glycemic control for postprandial treatment was not worse than preprandial treatment as assessed by fructosamine week 0 vs. 6 (mean Ϯ SD, preprandial 367 Ϯ 74 vs. 378 Ϯ 90 mol/l; postprandial 383 Ϯ 83 vs. 385 Ϯ 77 mol/l) and HbA 1c (preprandial 7.9 Ϯ 1.3 vs. 8.0 Ϯ 1.5%; postprandial 8.0 Ϯ 1.4 vs. 8.3 Ϯ 1.5%, P ϭ 0.14). The only statistically significant finding from the seven-point blood glucose profiles and derived parameters between preprandial and postprandial treatment was a lower postprandial glucose level 120 min after breakfast (mean Ϯ SEM, Ϫ2.08 Ϯ 0.74 mmol/l, P ϭ 0.016). The relative risk of hypoglycemia (blood glucose Ͻ3.9 mmol/l) preprandially to postprandially was not significantly different (mean 1.1; 95% CI 0.91-1.35; P ϭ 0.31). Overall treatment satisfaction was equally high for both regimens with both patients and parents. CONCLUSIONS -Although preprandial administration of insulin aspart is generally preferable, this study shows that in children and adolescents, postprandial administration of insulin aspart is a safe and effective alternative.