What question did this study set out to answer?

Evaluate the effects of prandial insulin timing on vascular function in people with type 1 diabetes.

July 12, 2026DiabetologiaOpen Access

Premeal insulin administration lowers postprandial blood glucose and increases myocardial microvascular blood flow in people with type 1 diabetes: a randomised, crossover clinical trial

Q: What are the key findings of this study?

Premeal insulin administration led to greater myocardial microvascular blood flow compared to postmeal administration in people with type 1 diabetes (P=0.044).

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Type 1 diabetes (n=36). Intervention: Premeal insulin administration (15 min before meal) vs. Postmeal insulin administration (15 min after meal). Primary outcome: Change in myocardial microvascular blood flow (MBF) within each protocol (p=0.044).

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Key result

Premeal insulin increases myocardial microvascular blood flow versus postmeal dosing in type 1 diabetes.

P=0.044
n=36

Why the study?

Does premeal insulin administration improve myocardial microvascular blood flow in people with type 1 diabetes?

Population

36 participants, aged 18 to 35 years with BMI <30 kg/m2.

Comparison

Prandial insulin injected 15 min before meal… vs Prandial insulin injected 15 min after meal…

Design

RCT, 1:1 randomised crossover design, Study personnel assessing outcomes were…

Follow-up

2 hours after meal ingestion

Authors

WHWilliam B. Horton KAKara C. AndersonUniversity of North Carolina at Chapel Hill KLKaitlin M. LoveAdventHealth Orlando

Discussion

Member takes

Implication

Premeal insulin timing may enhance postprandial myocardial microvascular flow in young adults with type 1 diabetes; leaves open clinical outcome benefits.

Key Points

Evaluate the effects of prandial insulin timing on vascular function in people with type 1 diabetes.
Randomized crossover design with 18 participants with type 1 diabetes and 18 matched controls.
Insulin administered 15 minutes before or after meals to measure postprandial outcomes.
Assessment of glucose levels, myocardial blood flow, and vascular function using ultrasound.
Postmeal insulin resulted in a significantly greater glucose area under the curve (p=0.015) compared to premeal insulin.
Premeal insulin significantly increased myocardial microvascular flow velocity (p=0.031) and myocardial blood flow (p=0.044).
No changes in myocardial blood flow were observed in the other protocols.

Study Design

Type

RCT (n=36)

Blinding

Masked outcome assessment

Randomization

1:1 crossover

Structured PICO

Does premeal insulin administration improve myocardial microvascular blood flow in people with type 1 diabetes?

Population

36 participants (18 with type 1 diabetes and 18 matched controls) aged 18-35 years with BMI <30 kg/m2, assessed 2 hours after meal ingestion.

Intervention

Prandial insulin injected 15 min before meal intake began.

Comparator

Prandial insulin injected 15 min after meal intake began (crossover design). Healthy controls consumed the same meal but received no exogenous insulin.

Outcome

Change in myocardial microvascular blood flow (MBF) within each protocol at 2 hours after meal ingestion.surrogate

Main Result

p-value: p=0.044

Appropriately timed premeal insulin lowers postprandial blood glucose and increases myocardial microvascular blood flow in young adults with type 1 diabetes.

Cite This Study

Horton et al. (2026) conducted an RCT in Type 1 diabetes (n=36). Premeal insulin administration (15 min before meal) vs. Postmeal insulin administration (15 min after meal) was evaluated on Change in myocardial microvascular blood flow (MBF) within each protocol (p=0.044). Premeal insulin administration led to greater myocardial microvascular blood flow compared to postmeal administration in people with type 1 diabetes (P=0.044).

synapsesocial.com/papers/6a5333754f7abc118adee146 https://doi.org/10.1007/s00125-026-06806-2

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Implication

Premeal insulin timing may enhance postprandial myocardial microvascular flow in young adults with type 1 diabetes; leaves open clinical outcome benefits.