A Kumar1, T Awata2, S C Bain3, A Ceriello4,5, G R Fulcher6, A G Unnikrishnan7, R Arechavaleta8, G Gonzalez-Gálvez9, T Hirose10, P D Home11, K Kaku12, L Litwak13, S Madsbad14, M Pinget15, R Mehta16, A Mithal17, M Tambascia18, J Tibaldi19, J S Christiansen20. 1. Diabetes Care & Research Centre, Patna, India. 2. Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan. 3. Diabetes Research Unit Cymru, Swansea University & ABM University Health Board, Swansea, UK. 4. Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain. 5. IRCCS MultiMedica, Milan, Italy. 6. University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia. 7. Chellaram Diabetes Institute, Pune, Maharashtra. 8. Departamento de Endocrinologia, Universidad Autónoma de Guadalajara, Zapopan, Mexico. 9. Instituto Jalisciense de Investigación en Diabetes y Obesidad S.C. Guadalajara, Jalisco, México. 10. Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo, Japan. 11. Newcastle University, Newcastle upon Tyne, UK. 12. Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan. 13. Endocrine, Metabolism and Nuclear Medicine Service, Diabetes Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 14. Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. 15. Department of Endocrinology, University of Strasbourg, Strasbourg, France. 16. Department of Endocrinology, National Institute of Medical Sciences and Nutrition, Salvador Zubirán, México City, Mexico. 17. Division of Endocrinology and Diabetes, Medanta the Medicity, Gurgaon, Haryana, India. 18. Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil. 19. Queens Diabetes and Endocrinology Associates, Fresh Meadows, New York, NY, USA. 20. Department of Clinical Medicine - The Department of Endocrinology and Diabetes, Aarhus University Hospital, NBG, Aarhus C, Denmark.
Abstract
AIMS: To provide a review of the available data and practical use of insulin degludec with insulin aspart (IDegAsp). Premixed insulins provide basal and prandial glucose control; however, they have an intermediate-acting prandial insulin component and do not provide as effective basal coverage as true long-acting insulins, owing to the physicochemical incompatibility of their individual components, coupled with the inflexibility of adjustment. The molecular structure of the co-formulation of IDegAsp, a novel insulin preparation, allows these two molecules to coexist without affecting their individual pharmacodynamic profiles. METHODS: Clinical evidence in phase 2/3 trials of IDegAsp efficacy and safety in type 1 and type 2 diabetes mellitus (T1DM and T2DM) have been assessed and summarised. RESULTS: In people with T2DM, once- and twice-daily dosing provides similar overall glycaemic control (HbA1c ) to current modern insulins, but with lower risk of nocturnal hypoglycaemia. In prior insulin users, glycaemic control was achieved with lower or equal insulin doses vs. other basal+meal-time or premix insulin regimens. In insulin-naïve patients with T2DM, IDegAsp can be started once or twice-daily, based on individual need. People switching from more than once-daily basal or premix insulin therapy can be converted unit-to-unit to once-daily IDegAsp, although this strategy should be assessed by the physician on an individual basis. CONCLUSIONS: IDegAsp offers physicians and people with T2DM a simpler insulin regimen than other available basal-bolus or premix-based insulin regimens, with stable daytime basal coverage, a lower rate of hypoglycaemia and some flexibility in injection timing compared with premix insulins.
AIMS: To provide a review of the available data and practical use of insulin degludec with insulin aspart (IDegAsp). Premixed insulins provide basal and prandial glucose control; however, they have an intermediate-acting prandial insulin component and do not provide as effective basal coverage as true long-acting insulins, owing to the physicochemical incompatibility of their individual components, coupled with the inflexibility of adjustment. The molecular structure of the co-formulation of IDegAsp, a novel insulin preparation, allows these two molecules to coexist without affecting their individual pharmacodynamic profiles. METHODS: Clinical evidence in phase 2/3 trials of IDegAsp efficacy and safety in type 1 and type 2 diabetes mellitus (T1DM and T2DM) have been assessed and summarised. RESULTS: In people with T2DM, once- and twice-daily dosing provides similar overall glycaemic control (HbA1c ) to current modern insulins, but with lower risk of nocturnal hypoglycaemia. In prior insulin users, glycaemic control was achieved with lower or equal insulin doses vs. other basal+meal-time or premix insulin regimens. In insulin-naïve patients with T2DM, IDegAsp can be started once or twice-daily, based on individual need. People switching from more than once-daily basal or premix insulin therapy can be converted unit-to-unit to once-daily IDegAsp, although this strategy should be assessed by the physician on an individual basis. CONCLUSIONS: IDegAsp offers physicians and people with T2DM a simpler insulin regimen than other available basal-bolus or premix-based insulin regimens, with stable daytime basal coverage, a lower rate of hypoglycaemia and some flexibility in injection timing compared with premix insulins.
Authors: Sarah J Glastras; Neale Cohen; Thomas Dover; Gary Kilov; Richard J MacIsaac; Margaret McGill; Greg R Fulcher Journal: J Clin Med Date: 2020-04-11 Impact factor: 4.241