1
|
Fulcher GR, Cohen ND, Davies K, d'Emden M, Glastras SJ, Mah PM, McCallum RW, Moses R, Thong KY, Roberts A. Initiating or switching to insulin degludec/insulin aspart in a real-world population of adults with type 2 diabetes in Australia: results from a prospective, non-interventional study. Intern Med J 2024. [PMID: 39171857 DOI: 10.1111/imj.16492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec and insulin aspart for the treatment of people with diabetes and suboptimal glycaemic control. Few real-world studies of IDegAsp treatment have been conducted. Here, we report results from the Australian cohort of the global ARISE study of real-world IDegAsp use. AIMS To investigate glycaemic control and other clinical outcomes in people with type 2 diabetes (T2D) treated with IDegAsp in a real-world setting in Australia. METHODS A total of 183 adults with T2D initiating or switching to IDegAsp in the Australian cohort of the open-label, non-interventional ARISE study were followed for 26-36 weeks from August 2019 to December 2020. RESULTS IDegAsp was associated with significant reductions from baseline to end of study (EOS) in mean glycated haemoglobin (estimated change -0.8% (95% confidence interval (CI): -1.05 to -0.56; P < 0.0001)), fasting plasma glucose (-1.6 mmol/L (95% CI: -2.49 to -0.63; P = 0.0017)) and body weight (-2.6 kg (95% CI: -3.68 to -1.55; P < 0.0001)). In insulin-experienced patients, the mean total daily insulin dose did not change significantly (estimated change from baseline to EOS 3.8 (95% CI: -3.70 to 11.21; P = 0.3202)). The proportion of patients experiencing hypoglycaemia numerically decreased during the study (non-severe: 14.2-10.9%; nocturnal non-severe: 4.9-2.2%; and severe: 2.2-0%). CONCLUSIONS Initiating or switching to IDegAsp in a real-world population of people with T2D in Australia was associated with significant improvements in glycaemic control and body weight, and numerically lower levels of hypoglycaemia compared with baseline.
Collapse
Affiliation(s)
- Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Michael d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Peak M Mah
- Department of Diabetes and Endocrinology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Roland W McCallum
- Diabetes and Endocrine Services, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Robert Moses
- Clinical Trial and Research Unit, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Ken Y Thong
- Department of Diabetes and Endocrinology, Rockingham General Hospital, Perth, Western Australia, Australia
| | - Anthony Roberts
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Chawla M, Chawla P, Saboo B, Chawla R, Gangopadhyay KK, Kalra S, Aravind S, Sinha B, Shah T, Kesavadev J, Rajput R. Scientific advisory on nocturnal hypoglycemia in insulin-treated patients with diabetes: Recommendations from Indian experts. Diabetes Metab Syndr 2022; 16:102587. [PMID: 36055167 DOI: 10.1016/j.dsx.2022.102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Insulin is one of the commonly prescribed glucose lowering agents in diabetes. Hypoglycemia is the most common complication, and severe hypoglycemia is the most serious complication of insulin therapy. Almost half of all severe hypoglycemia episodes (HEs) occur at night. However, patients are often unaware of their nocturnal hypoglycaemia (NH) risk. Additionally, both healthcare professionals and patients find it difficult to manage NH. The purpose of this expert group meeting is to improve NH awareness and provide guidance for the physicians to recognize and manage NH. METHOD The panel of experts in an e-board deliberated extensively upon the available literature and guidelines on hypoglycemia and NH discussed the consensus on definition, detection, reporting, monitoring, treatment, and optimization of therapy in NH. RESULT & Conclusion: Though there are many guidelines on the management of HEs in patients with diabetes, very few touch the topic of NH. This scientific advisory on management of NH in insulin treated patients with diabetes is formulated to address this gap in understanding regarding management of NH. The experts provide recommendations for the nocturnal window, defining NH based on blood glucose values, recognition, prevention and management of NH.
Collapse
Affiliation(s)
- M Chawla
- Lina Diabetes Care Centre, Mumbai, India.
| | - P Chawla
- Consultant Diabetologist and Director of Clinical Research, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - B Saboo
- Dept of Endocrinology, Dia Care, Ahmedabad, Gujrat, India
| | - R Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - K K Gangopadhyay
- Consultant in Endocrinology, CK Birla Hospitals, Peerless Hospital, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | | | - B Sinha
- AMRI and Fortis Hospitals, Kolkata, India
| | - T Shah
- Director and Diabetologist Iva Diabetes Care Centre Mumbai, Sl Raheja Fortis Hospital, Mumbai, India
| | - J Kesavadev
- Jothydev's Diabetes and Research Center, Kerala, India
| | - R Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
| |
Collapse
|
3
|
Oner H, Gunhan HG, Gogas Yavuz D. Intensification of Insulin Treatment With Insulin Degludec/Aspart in Type 2 Diabetic Patients: A 2-Year Real-World Experience. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:783277. [PMID: 36992737 PMCID: PMC10012153 DOI: 10.3389/fcdhc.2022.783277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 05/09/2022] [Indexed: 06/19/2023]
Abstract
AIM To evaluate the effects of insulin degludec/insulin aspart (IDegAsp) coformulation as an intensification of insulin treatment for glycemic control in patients with type 2 diabetes (T2D) in a long term real-world clinical setting. MATERIALS AND METHODS This retrospective non-interventional study, included 210 patients with T2D who to IDegAsp coformulation from prior insulin treatment in a tertiary endocrinology center between September 2017 and December 2019. The baseline data was taken as the index date and defined as the first IDegAsp prescription claim. Previous insulin treatment modalities, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and body weight were recorded, respectively at the 3rd, 6th, 12th, and 24th months of the IDegAsp treatment. RESULTS Out of the total 210 patients, 166 patients under insulin treatment switched to twice-daily IDegAsp treatment, 35 patients switched to once daily IDegAsp and twice premeal short-acting insulin regimen as a modified basal-bolus (BB) treatment, and nine patients commenced with once-daily IDegAsp treatment. HbA1c decreased from 9.2% ± 1.9% to 8.2% ± 1.6% in 6 months, 8.2% ± 1.7% in the first year, and 8.1% ± 1.6% in the second year of the therapy (p< 0.001). FPG decreased from 209.0 ± 85.0 mg/dL to 147.0 ± 62.6 mg/dL in the second year (p< 0.001). The required total daily dose of insulin increased in the second year of IDegAsp treatment compared to baseline. However, there was a borderline significance increase in IDegAsp requirement for the whole group at the two-year follow-up (p = 0.05). Patients who were administered twice daily IDegAsp injections required more total insulin in the first and second years due to added premeal short-acting insulin injections (p < 0.05). The frequency of patients with HbA1c < 7% was 31.8% in first year and 35.8% in second year under IDegAsp treatment.Insulin dose was de-escalated in 28.5% of the patients under BB treatment, while 15% under twice-daily IDegAsp required increased BB treatment. CONCLUSION Intensification of insulin treatment with IDegAsp coformulation improved glycemic control in patients with T2D. The total daily insulin requirement increased but the IDegAsp requirement lightly increased at the two-year follow-up. Patients under BB treatment required de-escalation of insulin treatment.
Collapse
Affiliation(s)
- Hatice Oner
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Hatice Gizem Gunhan
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
4
|
Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes: A Real-World, Prospective, Non-interventional Study Across Six Countries. Adv Ther 2022; 39:3735-3748. [PMID: 35752730 PMCID: PMC9244059 DOI: 10.1007/s12325-022-02212-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
Introduction Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (a basal insulin) and insulin aspart (a prandial insulin). The aim of this study was to investigate clinical outcomes in people with type 2 diabetes (T2D) after initiating IDegAsp treatment in a real-world setting. Methods This 26-week, open-label, non-interventional study was conducted in Australia, India, Malaysia, Philippines, Saudi Arabia, and South Africa. Data were obtained from 1102 adults with T2D initiating or switching to IDegAsp from antidiabetic treatments (including oral antidiabetic drugs, basal insulin, basal–bolus insulin, premix insulin, and glucagon-like peptide 1 receptor agonist) per local clinical practice. Results Compared with baseline, there was significant improvement in HbA1c at end of study (EOS, first visit within weeks 26–36; estimated change − 1.4% [95% CI − 1.51; − 1.29]; P < 0.0001 [primary outcome]). From baseline to EOS, there were significant reductions in fasting plasma glucose (− 2.7 mmol/L [95% CI − 2.98; − 2.46]; P < 0.0001), body weight (− 1.0 kg [95% CI − 1.51; − 0.52]; P < 0.0001), and basal insulin dose in insulin-experienced participants (− 2.3 units [95% CI − 3.51; − 1.01]; P < 0.001). The incidence rates of non-severe (overall and nocturnal) and severe hypoglycaemia decreased significantly (P < 0.001) between the period before baseline and before EOS. Conclusion In adults with T2D, initiating or switching to IDegAsp from previous antidiabetic treatment was associated with improved glycaemic control, lower basal insulin dose (in insulin-experienced participants), and lower rates of hypoglycaemia. Trial Registration Clinical trial registration NCT04042441. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02212-3.
Collapse
|
5
|
Edina BC, Tandaju JR, Wiyono L. Efficacy and Safety of Insulin Degludec/Insulin Aspart (IDegAsp) in Type 2 Diabetes: Systematic Review and Meta-Analysis. Cureus 2022; 14:e25612. [PMID: 35784980 PMCID: PMC9249063 DOI: 10.7759/cureus.25612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Type 2 diabetes mellitus is a prevalent metabolic disease requiring tight glycemic control of basal and postprandial glucose levels. Treatment intensification using separate basal and bolus injections increased the number of injections and reduced cost-effectivity, leading to decreased compliance and failure of glycemic control. Insulin Degludec/Insulin Aspart (IDegAsp), a novel premix of basal and bolus insulin, is one of the potential treatments for reducing the number of injections. However, its efficacy and safety have not been reviewed clearly. Therefore, this systematic review aims to compare the efficacy and safety of IDegAsp with standard basal and basal plus bolus insulin regimens. A systematic review of four databases (Pubmed, Scopus, Science Direct, and Proquest) was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Search results were screened by eligibility criteria and critically appraised by the Oxford Centre for Evidence-Based Medicine (CEBM) tool and the Cochrane risk-of-bias assessment tool. Meta-Analysis was done using Review Manager to obtain cumulative outcomes from hemoglobin A1C (HbA1C) changes, hypoglycemia incidents, and weight gain from all studies. Out of 132 search results, 10 studies were reviewed. IDegAsp once-daily administration was proven beneficial in reducing HbA1c levels and nocturnal hypoglycemia incidences, while IDegAsp twice-daily administration was proven beneficial in lowering hypoglycemia incidence and nocturnal hypoglycemia incidence. IDegAsp yielded better glycemic index results and lowered hypoglycemic incidents in the meta-analysis. Thus, it is concluded that IDegAsp once daily with stepwise titration on the largest meal of the day achieved most benefits with minimal risks.
Collapse
Affiliation(s)
- Brenda C Edina
- Faculty of Medicine, Universitas Indonesia, Jakarta, IDN
| | | | | |
Collapse
|
6
|
Yang W, Akhtar S, Franek E, Haluzík M, Hirose T, Kalyanam B, Kar S, Wu T, Gogas Yavuz D, Unnikrishnan AG. Postprandial Glucose Excursions in Asian Versus Non-Asian Patients with Type 2 Diabetes: A Post Hoc Analysis of Baseline Data from Phase 3 Randomised Controlled Trials of IDegAsp. Diabetes Ther 2022; 13:311-323. [PMID: 35044568 PMCID: PMC8873325 DOI: 10.1007/s13300-021-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Increased postprandial glucose (PPG) is associated with high glycated haemoglobin levels and is an independent risk factor for cardiovascular diseases. The aim of this study was to compare PPG increments in Asian versus non-Asian adults with type 2 diabetes (T2D), who were insulin-naïve or insulin-experienced, from the phase 3 insulin degludec/insulin aspart (IDegAsp) clinical trials. METHODS This was a post hoc analysis of data from 13 phase 3, randomised, parallel-group, open-label IDegAsp trials in patients with T2D. The pooled baseline clinical data were analysed for insulin-naïve and insulin-experienced groups; and each group was split into subgroups of Asian and non-Asian patients, respectively, and analysed accordingly. Baseline self-monitored blood glucose (SMBG) values at breakfast, lunch and the evening meal (before and 90 min after each meal) were used to assess PPG increments. The estimated differences in baseline SMBG increment between the Asian and non-Asian subgroups were analysed. RESULTS Clinical data from 4750 participants (insulin-naïve, n = 1495; insulin-experienced, n = 3255) were evaluated. In the insulin-naïve group, the postprandial SMBG increment was significantly greater in the Asian versus the non-Asian subgroup at breakfast (estimated difference 28.67 mg/dL, 95% confidence interval [CI] 18.35, 38.99; p < 0.0001), lunch (17.34 mg/dL, 95% CI 6.47, 28.21; p = 0.0018) and the evening meal (16.19 mg/dL, 95% CI 5.04, 27.34; p = 0.0045). In the insulin-experienced group, the postprandial SMBG increment was significantly greater in the Asian versus non-Asian subgroup at breakfast (estimated difference 13.81 mg/dL, 95% CI 9.19, 18.44; p < 0.0001) and lunch (29.18 mg/dL, 95% CI 24.22, 34.14; p < 0.0001), but not significantly different at the evening meal. CONCLUSION In this post hoc analysis, baseline PPG increments were significantly greater in Asian participants with T2D than in their non-Asian counterparts at all mealtimes, with the exception of the evening meal in insulin-experienced participants. Asian adults with T2D may benefit from the use of regimens that control PPG excursions. CLINICAL TRIAL NUMBERS NCT02762578, NCT01814137, NCT01513590, NCT01009580, NCT01713530, NCT02648217, NCT01045447, NCT01365507, NCT01045707, NCT01272193, NCT01059812, NCT01680341, NCT02906917.
Collapse
Affiliation(s)
- Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Shahid Akhtar
- Clinical, Medical and Regulatory Department, Novo Nordisk Pharma Gulf FZ-LLC, Dubai, United Arab Emirates
| | | | - Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | | | | | - Soumitra Kar
- Novo Nordisk Service Centre India Private Ltd., Bangalore, India
| | - Ted Wu
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | |
Collapse
|
7
|
Katabami T, Eriksen KT, Yamamoto Y, Ishigaki Y. Long-Term Safety and Clinical Outcomes with Insulin Degludec/Insulin Aspart Treatment in Japanese Patients with Diabetes: A Real-World, Prospective, Observational Study. Adv Ther 2022; 39:544-561. [PMID: 34800283 PMCID: PMC8799571 DOI: 10.1007/s12325-021-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
Introduction Insulin degludec/insulin aspart (IDegAsp) provides effective glycaemic control with an acceptable safety profile in Japanese patients with diabetes in randomised clinical trials. This post-marketing surveillance study assessed long-term safety and clinical outcomes with IDegAsp in a Japanese real-world setting. Methods Multicentre, prospective, observational, open-label, single-arm study of Japanese patients with diabetes requiring insulin therapy, who had switched to IDegAsp at their treating physician’s discretion in clinical practice. One year after initiating IDegAsp, incidence of adverse events (AEs [primary endpoint]), serious AEs, adverse drug reactions (ADRs), and severe hypoglycaemia (secondary safety endpoints) were assessed in the safety analysis set (SAS). Secondary effectiveness endpoints were change from baseline in glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) in the effectiveness analysis set (EAS). Results Overall, 1321 patients were included (SAS, n = 1321; EAS, n = 1285); 4.2% with type 1 diabetes, 95.2% with type 2 diabetes, 0.7% with other/unknown diabetes type. In total, 204 AEs were reported in 132 patients (10.0% of the SAS), at a rate [95% confidence interval (CI)] of 16.2 events/100 patient-years of exposure (PYE) [14.0; 18.4]. By preferred term, ‘hypoglycaemia’ was the most frequent AE (45 events in 31 patients [2.3%]; rate [95% CI] 3.6 events/100 PYE [2.5; 4.6]). Serious AEs occurred in 4.2% of patients (rate [95% CI] 5.7 events/100 PYE [4.4; 7.0]), and ADRs in 3.1% (rate [95% CI] 4.6 reactions/100 PYE [3.4; 5.8]). Six events of severe hypoglycaemia were reported in five patients (0.4%; rate [95% CI] 0.5 events/100 PYE [0.1; 0.9]). Change from baseline to 1 year was − 0.51% and − 32.1 mg/dL for HbA1c and FPG, respectively (P < 0.0001 for both). Conclusion In Japanese patients with diabetes, initiation of IDegAsp in real-world clinical practice was well tolerated, with no new safety signals, and associated with improved glycaemic control after 1 year.
Trial Registration ClinicalTrials.gov identifier, NCT02821052. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01978-2.
Collapse
|
8
|
Kovil R. Comparing time to intensification between insulin degludec/insulin aspart and insulin glargine: A single-center experience from India. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Kesavadev J, Gowda A, Kumar H, Yalamanchi SR, Lodha S, Singh KP, Basu D, Asirvatham A, Shah N, Pathan MK, Revanna M, Mukherjee JJ. Safety of Insulin Degludec/Insulin Aspart in Patients with Diabetes Mellitus over a Period of 1 Year during Routine Clinical Care in India: SMART (Study of Management of Diabetes with Ryzodeg™ Treatment). Med Sci (Basel) 2021; 10:1. [PMID: 35076540 PMCID: PMC8788540 DOI: 10.3390/medsci10010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
This post-authorization study was conducted to evaluate the safety of insulin degludec/insulin aspart (IDegAsp) in adult patients with diabetes mellitus (DM) during routine clinical care under a real-world setting in India. Eligible patients received IDegAsp for a minimum of 12 months during routine clinical management. Data were collected at 0, 3, 6, and 12 months. In total, 1029 adult patients with DM were included; 65.2% (n = 671) were men; mean age was 55.0 ± 12.2 years, and the mean duration of diabetes mellitus was 10.8 ± 7.4 years. Thirty adverse events were reported in 23 patients (2.2%) during the follow-up: two adverse events in two patients were serious with fatal outcomes, which were unrelated to IDegAsp use. At baseline, there were 176 confirmed hypoglycemic events in 67 (6.7%) patients while they were on their previous treatment options. At 12 months of treatment with IDegAsp, 11 confirmed hypoglycemic events were reported in 11 (1.1%) patients since the previous visit; there were no reported episodes of severe hypoglycemia. Mean glycosylated hemoglobin value reduced from 9.5% ± 1.8% at baseline to 7.7% ± 1.1% at 12 months. This study showed the safety of IDegAsp in patients with diabetes mellitus over a period of 1 year during routine clinical care.
Collapse
Affiliation(s)
| | - Ambanna Gowda
- Fortis Hospital, Cunningham Road, Bengaluru 560052, India;
| | - Harish Kumar
- Amrita Institute of Medical Sciences, Kochi 682041, India;
| | | | | | | | - Debasis Basu
- Apollo Gleneagles Hospital, Kolkata 700067, India; (D.B.); (J.J.M.)
| | | | | | | | - Manjunatha Revanna
- Novo Nordisk India Private Limited, Bengaluru 560066, India; (M.K.P.); (M.R.)
| | | |
Collapse
|
10
|
Gomez‐Peralta F, Al‐Ozairi E, Jude EB, Li X, Rosenstock J. Titratable fixed-ratio combination of basal insulin plus a glucagon-like peptide-1 receptor agonist: A novel, simplified alternative to premix insulin for type 2 diabetes. Diabetes Obes Metab 2021; 23:1445-1452. [PMID: 33651460 PMCID: PMC8252507 DOI: 10.1111/dom.14365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/17/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
Despite novel therapeutic options, many people with type 2 diabetes (T2D) do not achieve their HbA1c targets. Given the progressive nature of T2D, many individuals not controlled with oral therapy will require advancement to injectable therapy using either a glucagon-like peptide-1 receptor agonist (GLP-1 RA), recently recommended as a first option, or traditionally a basal insulin. However, premix insulins remain frequently used, either as initial injectable therapy or as intensification from basal insulin. Premix insulin injections can potentially provide significant glycaemic improvements to basal insulin but at the expense of increased hypoglycaemia and weight gain and the need for multiple daily doses, which may affect treatment adherence. Real-world evidence suggests that glycaemic control often remains suboptimal with premix insulins. Fixed-ratio combinations (FRCs) of basal insulin and GLP-1 RAs provide a novel alternative to premix insulin for therapy intensification. While no direct comparisons between premix insulins and FRCs are available, results from meta-analyses suggest that FRCs may offer better HbA1c reductions, a lower risk of hypoglycaemia and less weight gain compared with premix insulin in a simplified treatment regimen. A head-to-head trial of T2D treatment intensification with premix insulin and a FRC of basal insulin plus a GLP-1 RA is currently in progress, which should help to clarify the outcomes for each treatment option. This review discusses the unmet needs of people with T2D treated with premix insulin and provides evidence supporting FRCs of basal insulin and GLP-1 RAs as an alternative treatment option.
Collapse
Affiliation(s)
| | | | - Edward B. Jude
- Tameside and Glossop Integrated Care NHS Foundation TrustAshton‐under‐LyneUK
- University of ManchesterManchesterUK
| | - Xiaoying Li
- Department of Endocrinology, Zhongshan HospitalFudan UniversityShanghaiChina
| | | |
Collapse
|
11
|
Aso Y, Takada Y, Tomotsune K, Chiba Y, Matsumura M, Jojima T, Sato M, Fujita N, Kuroda H, Murano S, Usui I. Comparison of insulin degludec (IDeg)/insulin Aspart (IAsp) co-formulation therapy twice-daily with free combination of GLP-1 receptor agonist liraglutide plus insulin degludec in Tochigi: IDEAL Trial. Int J Clin Pract 2021; 75:e13734. [PMID: 33099848 DOI: 10.1111/ijcp.13734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/18/2020] [Indexed: 01/03/2023] Open
Abstract
AIM We compared the efficacy and safety of insulin degludec/insulin aspart co-formulation (IDegAsp) twice-daily to a free combination of basal insulin degludec and GLP-1 receptor agonist liraglutide (IDeg + Lira) once-daily for patients with inadequately controlled type 2 diabetes on insulin therapy and oral antidiabetic drugs. SUBJECTS AND METHODS Eligible patients were randomly allocated at a 1:1 ratio to receive either the once-daily dual injection of IDeg + Lira (n = 24) or twice-daily single injection of IDegAsp (n = 28). The primary endpoints were as follows: HbA1c changes over 52 weeks of treatment and the percentage of participants achieving HbA1c < 7.0% at week 52. RESULTS After 52 weeks, HbA1c decreased by 0.3% in the IDegAsp group and by 0.7% in the IDeg + Lira group. The HbA1c reduction was greater in the IDeg + Lira group than in the IDegAsp group. 19% of patients on IDegAsp versus 40% on IDeg + Lira achieved HbA1c < 7.0%. Pre-breakfast and pre-dinner blood glucose at 52 weeks were significantly lower in the IDeg + Lira group than in the IDegAsp group. The reduction in body mass index (BMI) was greater in the IDeg + Lira group than in the IDegAsp group throughout the study period. The confirmed hypoglycaemia rates were 1.32 and 0.69 per patient/year of exposure to IDegAsp and IDeg + Lira, respectively. CONCLUSIONS In patients with inadequately controlled type 2 diabetes on insulin therapy and oral antidiabetic drugs, treatment with the once-daily dual injection of IDeg + Lira compared with the twice-daily single injection of IDegAsp showed no significant difference in glycaemic control but statistically superior weight loss.
Collapse
Affiliation(s)
- Yoshimasa Aso
- Department of Endocrinology and Metabolism, Dokkyo Medical University, Mibu, Tochigi, Japan
| | | | - Ken Tomotsune
- Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | | | | | - Teruo Jojima
- Department of Endocrinology and Metabolism, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Minoru Sato
- NHO Utsunomiya National Hospital, Utsunomiya, Tochigi, Japan
| | | | | | | | - Isao Usui
- Department of Endocrinology and Metabolism, Dokkyo Medical University, Mibu, Tochigi, Japan
| |
Collapse
|
12
|
Jammah AA. Indirect comparison of efficacy and safety of insulin glargine/lixisenatide and insulin degludec/insulin aspart in type 2 diabetes patients not controlled on basal insulin. Prim Care Diabetes 2021; 15:132-137. [PMID: 32839127 DOI: 10.1016/j.pcd.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/29/2020] [Accepted: 08/05/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fixed-dose combinations of insulin glargine/lixisenatide (IGlarLixi) or insulin degludec/insulin aspart (IDegAsp) constitute treatment intensification in type 2 diabetes mellitus (T2D). OBJECTIVES Compare efficacy and safety of IGlarLixi and IDegAsp (as intensification from basal insulin), by indirect comparison of phase III trials, in the absence of head-to-head trials. STUDY ELIGIBILITY CRITERIA Studies comparing treatment intensification by once-daily IDegAsp or IGlarLixi to basal insulin. Data were extracted from two trials (BOOST: Intensify-Basal and LixiLan-L) retained for analysis. SYNTHESIS METHODS Treatments were compared in terms of estimated treatment difference (ETD) in glycated haemoglobin (HbA1c), fasting and postprandial plasma glucose (FPG and PPG) change from baseline; in addition to hypoglycaemia incidence and weight changes. RESULTS In a fixed-effect model examining HbA1c control, IGlarLixi was more effective than IDegAsp in reducing HbA1c (ETD 0.53%, P<0.0001]), PPG (ETD 2.65%, P<0.0001), and body weight (ETD 1.73kg, P<0.0001). Patients on IGlarLixi were more likely to achieve HbA1c<7% than patients on IDegAsp (odds ratio [OR]=0.40, P<0.0001), with lower incidence of hypoglycaemia (OR=1.33, P<0.001). LIMITATIONS Limited number of studies; different baseline HbA1c and FPG. CONCLUSION Once-daily IGlarLixi is more efficient than once-daily IDegAsp in controlling HbA1c and PPG and associates with greater weight loss and lower hypoglycaemia incidence.
Collapse
Affiliation(s)
- Anwar Ali Jammah
- Department of Medicine, King Saud University, P.O. Box 2925 (38) Riyadh 11461, Saudi Arabia.
| |
Collapse
|
13
|
Demir T, Turan S, Unluhizarci K, Topaloglu O, Tukek T, Gogas Yavuz D. Use of Insulin Degludec/Insulin Aspart in the Management of Diabetes Mellitus: Expert Panel Recommendations on Appropriate Practice Patterns. Front Endocrinol (Lausanne) 2021; 12:616514. [PMID: 33776914 PMCID: PMC7996092 DOI: 10.3389/fendo.2021.616514] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (IDeg), which provides long-lasting basal insulin coverage, and insulin aspart (IAsp), which targets post-prandial glucose. This expert panel aimed to provide a practical and implementable guidance document to assist clinicians in prescribing IDegAsp in the diabetes management with respect to different patient populations including children and adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) as well as pregnant, elderly and hospitalized patients and varying practice patterns (insulin-naive, insulin-treated, switching from basal, basal bolus and premix regimens). The experts recommended that IDegAsp can be used in insulin-naive T2D patients with poor glycemic control (HbA1c >8.5%) despite optimal oral antidiabetic drugs (OADs) as well as in insulin-treated T2D patients by switching from basal insulin, basal-bolus therapy or premixed insulins in relation to lower risk of nocturnal hypoglycemia, fewer injections and lower intraday glycemic variability, respectively. The experts considered the use of IDegAsp in children with T2D as a basal bolus alternative rather than as an alternative to basal insulin after metformin failure, use of IDegAsp in adult T1D patients as a simplified basal bolus regimen with lesser nocturnal hypoglycemia, fewer injections and better fasting plasma glucose control and in children with T1D as an alternative insulin regimen with fewer injection to increase treatment adherence. The proposed expert opinion provides practical information on use of IDegAsp in different patient populations and practice patterns to assist clinicians, which seems to compensate the need for easily implementable guidance on this novel insulin regimen.
Collapse
Affiliation(s)
- Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Serap Turan
- Department Pediatric Endocrinology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology and Metabolism, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Tufan Tukek
- Department of Endocrinology and Metabolism, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University Faculty of Medicine, Istanbul, Turkey
- *Correspondence: Dilek Gogas Yavuz,
| |
Collapse
|
14
|
Mehta R, Chen R, Hirose T, John M, Kok A, Lehmann R, Unnikrishnan AG, Yavuz DG, Fulcher G. Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines. Diabetes Obes Metab 2020; 22:1961-1975. [PMID: 32618405 PMCID: PMC7689716 DOI: 10.1111/dom.14128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022]
Abstract
Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec, which provides long-lasting basal insulin coverage, and insulin aspart, which targets postprandial glycaemia. This review provides expert opinion on the practical clinical use of IDegAsp, including: dose timings relative to meals, when and how to intensify treatment from once-daily (OD) to twice-daily (BID) dose adjustments, and use in special populations (including hospitalized patients). IDegAsp could be considered as one among the choices for initiating insulin treatment, preferential to starting on basal insulin alone, particularly for people with severe hyperglycaemia and/or when postprandial hyperglycaemia is a major concern. The recommended starting dose of IDegAsp is 10 units with the most carbohydrate-rich meal(s), followed by individualized dose adjustments. Insulin doses should be titrated once weekly in two-unit steps, guided by individualized fasting plasma glucose targets and based on patient goals, preferences and hypoglycaemia risk. Options for intensification from IDegAsp OD are discussed, which should be guided by HbA1c, prandial glucose levels, meal patterns and patient preferences. Recommendations for switching to IDegAsp from basal insulin, premixed insulins OD/BID, and basal-plus/basal-bolus regimens are discussed. IDegAsp can be co-administered with other antihyperglycaemic drugs; however, sulphonylureas frequently need to be discontinued or the dose reduced, and the IDegAsp dose may need to be decreased when sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists are added. Considerations around the initiation or continuation of IDegAsp in hospitalized individuals are discussed, as well as in those undergoing medical procedures.
Collapse
Affiliation(s)
- Roopa Mehta
- Unidad de Investigación en Enfermedades Metabólicas, Departamento de Endocrinología y MetabolismoInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Roger Chen
- Department of EndocrinologySt Vincentʼs HospitalSydneyAustralia
- University of New South Wales, Office of Medical EducationUniversity of SydneySydneyAustralia
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of MedicineToho University School of MedicineTokyoJapan
| | - Mathew John
- Providence Endocrine and Diabetes Specialty CentreThiruvananthapuramKeralaIndia
| | - Adri Kok
- Netcare Union and Clinton HospitalsAlbertonSouth Africa
- University of WitwatersrandJohannesburgSouth Africa
| | - Roger Lehmann
- Department of EndocrinologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Dilek Gogas Yavuz
- Department of Endocrinology and MetabolismMarmara University School of MedicineIstanbulTurkey
| | - Gregory Fulcher
- Northern Clinical SchoolUniversity of SydneySydneyAustralia
- Department of Diabetes, Endocrinology & MetabolismRoyal North Shore Hospital, University of SydneySydneyAustralia
| |
Collapse
|
15
|
Home P, Blonde L, Kalra S, Ji L, Guyot P, Brulle-Wohlhueter C, Murray E, Shah R, Sayre T, Shaunik A. Insulin glargine/lixisenatide fixed-ratio combination (iGlarLixi) compared with premix or addition of meal-time insulin to basal insulin in people with type 2 diabetes: A systematic review and Bayesian network meta-analysis. Diabetes Obes Metab 2020; 22:2179-2188. [PMID: 32700442 DOI: 10.1111/dom.14148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
AIM To assess the efficacy and safety of iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL and lixisenatide, relative to premix insulin and other insulin options through network meta-analysis. METHODS A systematic literature search identified randomized controlled trials (RCTs) comparing iGlarLixi, premix insulin or basal insulin (BI) in combination with meal-time insulin, in people inadequately controlled with BI. Eligible RCTs were compared using Bayesian network meta-analysis. RESULTS Eight RCTs, some open-label, involving 3538 participants, with a study duration of 24-30 weeks were included. The estimated difference in HbA1c reduction with iGlarLixi compared with premix insulin was -0.50%-units (95% credible interval: -0.93 to -0.06) with 98% probability of iGlarLixi being superior to premix. Estimates for iGlarLixi versus meal-time + BI (thrice-daily meal-time insulin + basal) and basal-plus (once-daily meal-time insulin + BI) were -0.35 (-0.89 to +0.13)%-units and -0.68 (-1.18 to -0.17)%-units with probabilities of real difference of 94% and 99%, respectively. Safety outcome analysis suggested that iGlarLixi had lower rates of both confirmed and documented symptomatic hypoglycaemia compared with premix insulin (probabilities of 85% and 93%, respectively) and lower weight gain (probability 98%). CONCLUSIONS iGlarLixi showed similar or improved efficacy and safety versus other intensification choices from BI included in this study, providing a clinically relevant treatment option in people with type 2 diabetes not well controlled on BI.
Collapse
Affiliation(s)
- Philip Home
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Linong Ji
- Peking University People's Hospital, Beijing, China
| | - Patricia Guyot
- Global Medical Affairs, Sanofi, Bridgewater, New Jersey, USA
| | | | - Erin Murray
- Doctor Evidence, Santa Monica, California, USA
| | - Roshan Shah
- Doctor Evidence, Santa Monica, California, USA
| | - Toby Sayre
- Doctor Evidence, Santa Monica, California, USA
| | - Alka Shaunik
- Global Medical Affairs, Sanofi, Bridgewater, New Jersey, USA
| |
Collapse
|
16
|
Glastras SJ, Cohen N, Dover T, Kilov G, MacIsaac RJ, McGill M, Fulcher GR. The Clinical Role of Insulin Degludec/Insulin Aspart in Type 2 Diabetes: An Empirical Perspective from Experience in Australia. J Clin Med 2020; 9:jcm9041091. [PMID: 32290465 PMCID: PMC7230791 DOI: 10.3390/jcm9041091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Treatment intensification in people with type 2 diabetes following failure of basal insulin commonly involves the addition of a rapid-acting insulin analogue (basal plus one or more prandial doses; multiple daily injections) or by a switch to premixed insulin. Insulin degludec/insulin aspart (IDegAsp), comprising rapid-acting insulin aspart and ultra-long-acting insulin degludec in solution, enables both fasting and post-prandial glucose control, with some advantages over other treatment intensification options. These include straightforward dose titration, flexibility in dose timing, low injection burden, simplicity of switching and a lower risk of hypoglycaemia. In Australia, where insulin degludec on its own is not available, IDegAsp enables patients to still benefit from its ultra-long-acting properties. This review aims to provide guidance on where and how to use IDegAsp. Specifically, guidance is included on the initiation of IDegAsp in insulin-naïve patients, treatment intensification from basal insulin, switching from premixed or basal-bolus insulin to IDegAsp, up-titration from once- to twice-daily IDegAsp and the use of IDegAsp in special populations or situations.
Collapse
Affiliation(s)
- Sarah J. Glastras
- Department of Diabetes, Endocrinology and Metabolism, The Royal North Shore Hospital, University of Sydney, Reserve Road, St Leonards NSW 2065, Australia;
- Correspondence: ; Tel.: +61-2-9463-1680
| | - Neale Cohen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia;
| | - Thomas Dover
- Ipswich Hospital, University of Queensland, Chelmsford Avenue, Ipswich QLD 4305, Australia;
- Mater Hospital Brisbane, Raymond Terrace, South Brisbane QLD 4101, Australia
| | - Gary Kilov
- Launceston Diabetes Clinic, 247 Wellington Street, Launceston TAS 7250, Australia;
- Department of General Practice and Primary Health Care, University of Melbourne, 230 Gratton Street, Parkville VIC 3010, Australia
| | - Richard J. MacIsaac
- Department of Endocrinology & Diabetes, St Vincent’s Hospital Melbourne, University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia;
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia;
| | - Greg R. Fulcher
- Department of Diabetes, Endocrinology and Metabolism, The Royal North Shore Hospital, University of Sydney, Reserve Road, St Leonards NSW 2065, Australia;
| |
Collapse
|
17
|
Özçelik S, Çelik M, Vural A, Aydın B, Özçelik M, Gozu H. Outcomes of transition from premixed and intensive insulin therapies to insulin aspart/degludec co-formulation in type 2 diabetes mellitus: a real-world experience. Arch Med Sci 2020; 17:1-8. [PMID: 33488849 PMCID: PMC7811302 DOI: 10.5114/aoms.2020.93264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION To evaluate the efficacy and safety of transition from premixed and intensive insulin to twice-daily insulin degludec/aspart (IDegAsp) co-formulation in patients with type 2 diabetes mellitus. MATERIAL AND METHODS In this 12-week study, patients receiving twice-daily premixed insulin therapy in group 1 (n = 55) were switched to twice-daily IDegAsp. In group 2 (n = 60), patients on intensive insulin therapy were switched to IDegAsp injected twice a day. Inter- and intragroup comparisons were made. RESULTS A total of 115 patients were included in the study. There was a significant improvement in glycaemic control, median daily total insulin dose, body mass, body mass index, and hypoglycaemic events in group 1 and group 2 with the switch to IDegAsp (p < 0.05). The decrease in median daily total insulin dose requirement in group 2 was higher than that of group 1 (p = 0.001). There was no difference between groups in terms of other parameters (p > 0.05). CONCLUSIONS The current analysis indicates that IDegAsp treatment improves outcomes, with the most notable differences observed in daily total insulin requirement, body mass, and hypoglycaemia.
Collapse
Affiliation(s)
- Serhat Özçelik
- Department of Endocrinology and Metabolism, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Mehmet Çelik
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Antalya Kepez State Hospital, Kepez, Turkey
| | - Aşkı Vural
- Division of Internal Medicine, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Bünyamin Aydın
- Department of Endocrinology and Metabolism, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Melike Özçelik
- Department of Internal Diseases, Umraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Hulya Gozu
- Department of Endocrinology and Metabolism, Marmara University Training and Research Hospital, Turkey
| |
Collapse
|
18
|
Kalra S, Deb P, Gangopadhyay KK, Gupta S, Ahluwalia A. Capacity and confidence building for general practitioners on optimum insulin use. J Family Med Prim Care 2019; 8:3096-3107. [PMID: 31742126 PMCID: PMC6857385 DOI: 10.4103/jfmpc.jfmpc_635_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes is characterised by a progressive decline in insulin secretion, and sooner or later patients require insulin therapy. However, physicians are reluctant to initiate insulin therapy because of perceived inadequacy in managing insulin therapy, cost and lack of benefits. Experts from across the country met at a workshop during 12th National Insulin Summit which was held in September at Hyderabad and came up with key recommendations to build capacity and confidence in general practitioners for insulin usage. Barriers can be overcome through self-education and training; effective patient education; imparting coping skill training to patients; and bridging gaps to improve adherence. Moreover, optimum insulinization requires knowledge about the available options for initiation and intensification of insulin therapy; various insulin regimens; dosing and titration; and choosing effective and simple insulin therapy as per patient characteristics. Hence, the objective of this review article is to help build capacity and confidence among general practitioners on optimising insulin therapy.
Collapse
Affiliation(s)
| | - Prasun Deb
- KIMS Hospitals, Minister Road, Secunderabad, Telangana, India
| | | | - Sunil Gupta
- Diabetes Care and Research Centre, Nagpur, Maharashtra, India
| | | |
Collapse
|
19
|
Kalra S, Atkin S, Cervera A, Das AK, Demir O, Demir T, Fariduddin M, Vo KT, Ku BJ, Kumar A, Latif ZA, Malek R, Matawaran BJ, Mehta R, Tran NQ, Panelo A, Ruder S, Saldana JR, Shaikh KA, Shakya A, Shrestha D, Unnikrishnan AG. Multinational Consensus: Insulin Initiation with Insulin Degludec/Aspart (IDegAsp). Adv Ther 2018; 35:928-936. [PMID: 29796928 PMCID: PMC11343968 DOI: 10.1007/s12325-018-0712-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Indexed: 12/13/2022]
Abstract
Insulin degludec/aspart (IDegAsp) is the first soluble insulin co-formulation, combining a long-acting insulin degludec (IDeg) and rapid-acting insulin aspart (IAsp). In type 2 diabetes patients with oral antidiabetes agent (OAD) inadequacy, insulin initiation with IDegAsp once daily provides superior long-term glycemic control compared to insulin glargine, with similar fasting plasma glucose (FPG) and insulin doses, and numerically lower rates of overall and nocturnal hypoglycemia. Furthermore, in patients with uncontrolled type 2 diabetes previously treated with insulins, IDegAsp twice daily effectively improves glycated hemoglobin and FPG, with fewer hypoglycemic episodes versus premix insulins and basal bolus therapy. In patients with type 1 diabetes mellitus, IDegAsp once daily with two doses of IAsp is a convenient, yet effective, regimen as compared to the conventional 4-5 injection-based basal bolus therapy. IDegAsp is an appropriate and reasonable option for initiation of insulin therapy in both type 1 and type 2 diabetes.
Collapse
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital Karnal, Karnal, India.
| | - Stephen Atkin
- Department of Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Antonio Cervera
- Department of Endocrinology, Clínica de Mérida, Mérida, Yucatán, Mexico
| | | | - Ozgur Demir
- Department of Endocrinology and Metabolic Diseases, İbni Sina Hospital, Ankara, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolic Disease, Dokuz Eylul University, Balcova, İzmir, Turkey
| | - Md Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Khoa Tuan Vo
- Department of Endocrinology, 115 Hospital, Ho Chi Minh City, Vietnam
| | - Bon Jeong Ku
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ajay Kumar
- Department of Diabetology, Diabetes Care and Research Center, Patna, Bihar, India
| | - Zafar A Latif
- Department of Endocrinology, General, BIRDEM Hospital, BIRDEM Academy, Dhaka, Bangladesh
| | - Rachid Malek
- Department of Medicine, Ferhat Abbas University of Setif, Setif, Algeria
| | - Bien J Matawaran
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Santo Tomas, Manila, Philippines
| | - Roopa Mehta
- Department of Endocrinology and Nutritión, Instituto nacional de ciencias médicas y nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Nam Quang Tran
- Head of Endocrinology Department, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Araceli Panelo
- Department of Medicine, UERMMMC College of Medicine, Manila, Philippines
| | - Sundeep Ruder
- Department of Endocrinology and Metabolism, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | | | - Khalid A Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Amit Shakya
- Department of Endocrinology, Diabetes Thyroid Endocrine Center, Kathmandu, Nepal
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | | |
Collapse
|
20
|
Haluzík M, Fulcher G, Pieber TR, Bardtrum L, Tutkunkardas D, Rodbard HW. The co-formulation of insulin degludec and insulin aspart lowers fasting plasma glucose and rates of confirmed and nocturnal hypoglycaemia, independent of baseline glycated haemoglobin levels, disease duration or body mass index: A pooled meta-analysis of phase III studies in patients with type 2 diabetes. Diabetes Obes Metab 2018; 20:1585-1592. [PMID: 29451706 PMCID: PMC6033009 DOI: 10.1111/dom.13261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 01/17/2023]
Abstract
AIMS To investigate whether the proven benefits of insulin degludec (IDeg) combined with insulin aspart (IAsp), known as IDegAsp, given twice daily, extend across a wide spectrum of patients with diabetes. MATERIALS AND METHODS This was a post hoc pooled analysis of 5 phase III randomized, 26-week, open-label, treat-to-target trials comparing IDegAsp twice daily (n = 1111) with one of two comparators: premixed insulin (biphasic insulin aspart 30 [BIAsp 30]) twice daily (n = 561) or IDeg once daily + IAsp (n = 136). Patient data were stratified according to baseline glycated haemoglobin (HbA1c) or fasting plasma glucose (FPG) categories, as well as by baseline duration of diabetes or body mass index (BMI) categories. RESULTS We conducted a meta-analysis of 5 clinical trials: NCT01513590, NCT01009580, NCT01059812, NCT01680341 and NCT01713530. End-of-trial results were broadly consistent, with differences between IDegAsp and comparators observed in phase III trials. HbA1c results were similar for IDegAsp and the comparators in all baseline characteristic (HbA1c, duration of diabetes or BMI) and category groups (number ranges). Significantly lower FPG level was observed with IDegAsp vs comparators in all baseline characteristic and most category groups (excluding FPG <5.5 mmol/L). Significantly lower insulin doses were observed with IDegAsp vs comparators in all baseline characteristic and half of the category groups, and significantly lower rates of confirmed and nocturnal confirmed hypoglycaemia were observed with IDegAsp vs comparators in all baseline variable and category groups. CONCLUSIONS IDegAsp retains a consistent safety and efficacy profile in patients with different baseline characteristics.
Collapse
Affiliation(s)
- Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles UniversityPragueCzech Republic
| | - Greg Fulcher
- Royal North Shore HospitalUniversity of SydneySydneyAustralia
| | | | | | | | | |
Collapse
|
21
|
Haahr H, Fita EG, Heise T. A Review of Insulin Degludec/Insulin Aspart: Pharmacokinetic and Pharmacodynamic Properties and Their Implications in Clinical Use. Clin Pharmacokinet 2017; 56:339-354. [PMID: 27696221 PMCID: PMC5340839 DOI: 10.1007/s40262-016-0455-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Insulin degludec/insulin aspart (IDegAsp; 70 % IDeg and 30 % IAsp) is a soluble combination of two individual insulin analogues in one product, designed to provide mealtime glycaemic control due to the IAsp component and basal glucose-lowering effect from the IDeg component. The pharmacokinetic and pharmacodynamic characteristics of IDegAsp have been investigated in a series of clinical pharmacology studies with generally comparable designs, methodologies and patient inclusion/exclusion criteria. The glucose-lowering effect profile of IDegAsp during once-daily dosing at steady state shows distinct and clearly separated action from the prandial and basal components of IDegAsp. The IAsp component provides rapid onset and peak glucose-lowering effect followed by a flat glucose-lowering effect lasting beyond 30 h due to IDeg. During twice-daily dosing, the distinct peak effect and the flat basal effect are retained following each dose. The pharmacological properties of IDegAsp are maintained in the elderly, children, adolescents, Japanese patients and those with hepatic or renal impairment. The potential clinical benefits associated with the pharmacological properties of IDegAsp have been verified in phase III clinical trials comparing IDegAsp with three other currently available treatment options: premixed insulin, basal-bolus regimens and basal-only therapy. IDegAsp shows favourable clinical benefits compared with biphasic insulin aspart 30 and is a viable alternative to basal-bolus and basal-only therapy. This review presents the results from clinical pharmacology studies conducted with IDegAsp to date, and extrapolates these results to clinical use of IDegAsp in the context of findings from the IDegAsp clinical therapeutic studies.
Collapse
Affiliation(s)
- Hanne Haahr
- Clinical Pharmacology, Novo Nordisk A/S, Vandtårnsvej 114, 2860, Søborg, Denmark.
| | - Edmond G Fita
- Global Medical Affairs, Novo Nordisk A/S, Vandtårnsvej 114, 2860, Søborg, Denmark
| | - Tim Heise
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460, Neuss, Germany
| |
Collapse
|
22
|
Ghosh S, Unnikrishnan AG, Saboo B, Kesavadev J, Aravind SR, Bajaj S, Rajput R, Seshadri K, Verma N, Gupta A, Makkar BM, Saikia M, Kale S, Damodaran S, Dengra A, Eashwar TKM, Maheshwari A, Pendsey S, Phatak SR, Sharma SK, Singh SK, Ramachandran A, Zargar AH, Joshi SR, Sadikot SM. Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes. Diabetes Metab Syndr 2017; 11 Suppl 1:S507-S521. [PMID: 28433618 DOI: 10.1016/j.dsx.2017.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Indexed: 01/27/2023]
Abstract
Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients' exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy.
Collapse
Affiliation(s)
- Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
| | | | | | | | | | - Sarita Bajaj
- Department of Medicine, Motilal Nehru Medical College, Allahabad, India
| | - Rajesh Rajput
- Department of Endocrinology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Krishna Seshadri
- Department of Endocrinology and Metabolism, Shri Rama Chandra University, Chennai, India
| | | | | | | | | | | | | | - Ashish Dengra
- Mahi Diabetes & Thyroid Care and Research Center, Jabalpur, India
| | | | - Anuj Maheshwari
- Department of Medicine, Babu Banarasi Das University, Lucknow, India
| | | | | | | | - Surya Kumar Singh
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Abdul H Zargar
- Advanced Center for Diabetes and Endocrine Care, Srinagar, India
| | - Shashank R Joshi
- Lilavati and Bhatia Hospital and Grant Medical College, Mumbai, India
| | | |
Collapse
|
23
|
Hirose T, Awata T, Yamamoto Y, Hemmingsen MP. Clinical considerations for use of insulin degludec/insulin aspart in Japanese patients. Expert Opin Biol Ther 2017; 18:77-85. [PMID: 29017373 DOI: 10.1080/14712598.2018.1389888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Co-formulation of basal and bolus insulin components provides a simpler regimen for patients with type 2 diabetes than separate basal-bolus treatment. However, conventional premixed insulin products include a suboptimal protaminated basal component that requires resuspension prior to injection. Insulin degludec/insulin aspart (IDegAsp) is the first soluble co-formulation of a basal insulin with an ultra-long duration of action (IDeg) and a rapid-acting bolus insulin (IAsp) in a single injection. AREAS COVERED In this review, the authors summarize findings from pre-clinical studies and the clinical trial program and provide guidance for the initiating and switching of IDegAsp in different patient populations. Pharmacodynamic analyses have revealed a rapid onset of action and distinct peak (IAsp), followed by a separate, flat and stable basal effect (IDeg component). Phase 3 studies have demonstrated the efficacy and safety of IDegAsp, with greater glycemic improvements than basal-only therapy in international and Japanese type 2 diabetes populations. IDegAsp also results in reduced insulin dose requirements and lower rates of hypoglycemia than premixed insulin. EXPERT OPINION IDegAsp provides a simple and effective insulin regimen in appropriately selected Japanese patients, with the flexibility to suit individual needs. The benefits of IDegAsp over conventional insulin regimens might help tackle clinical inertia with insulin intensification.
Collapse
Affiliation(s)
- Takahisa Hirose
- a Division of Diabetes, Metabolism and Endocrinology, Department of Medicine , Toho University School of Medicine , Tokyo , Japan
| | - Takuya Awata
- b Department of Diabetes, Endocrinology and Metabolism , International University of Health and Welfare Hospital , Tochigi , Japan
| | - Yuiko Yamamoto
- c Medical & Scientific Affairs Department , Novo Nordisk Pharma Ltd , Tokyo , Japan
| | - Mads Peter Hemmingsen
- d Medical & Scientific Affairs Department , Novo Nordisk Pharma Ltd ., Tokyo , Japan
| |
Collapse
|
24
|
Bebakar WMW, Chaykin L, Hersløv ML, Rasmussen S. Intensification of IDegAsp Twice Daily (Adding Insulin Aspart vs. Switching To Basal-Bolus): Exploratory Randomized Trial in Type 2 Diabetes. Diabetes Ther 2017; 8:197-205. [PMID: 27853981 PMCID: PMC5306112 DOI: 10.1007/s13300-016-0213-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In a preceding trial comparing two different titration schemes, insulin degludec/insulin aspart (IDegAsp) showed good efficacy for achieving HbA1c <7% when administered twice daily (BID) in patients with uncontrolled type 2 diabetes (T2D). However, poor glycemic control persisted in a minority of patients. The current exploratory trial investigated the efficacy and safety of intensifying IDegAsp BID treatment in these patients by either adding a once-daily (OD) bolus injection of insulin aspart (IAsp) or by switching to a basal-bolus regimen of insulin degludec (IDeg) plus IAsp taken three times a day (TID). METHOD A 26-week, randomized, open-label, phase 3b, treat-to-target trial in which 40 patients with T2D who had not reached target HbA1c ≤7.0% following previous 26-week treatment intensification with IDegAsp BID ±3 oral antidiabetic agents (OADs) were randomized (1:1) to receive IDegAsp BID + IAsp OD (n = 20) or IDeg OD + IAsp TID (n = 20). RESULTS Mean baseline HbA1c was 7.9% in the IDegAsp BID + IAsp OD group and 7.7% in the IDeg OD + IAsp TID group. After 26 weeks, the estimated mean change in HbA1c from baseline was 0.05% points in the IDegAsp BID + IAsp OD group and -0.49% points for IDeg OD + IAsp TID: estimated treatment difference (ETD) [95% confidence interval] 0.54% [0.09; 0.99], p = 0.021. Few achieved HbA1c <7% in IDegAsp BID + IAsp OD (four patients) and IDeg OD + IAsp TID groups (five patients). Fasting plasma glucose, hypoglycemia, and adverse events were similar between groups. CONCLUSION When used as intensification regimens in patients who failed to achieve target HbA1c during 26-week IDegAsp BID treatment, HbA1c improvements were numerically greater with IDeg OD + IAsp TID compared with IDegAsp BID + IAsp OD. No new safety issues were identified. However, the small, selective sample means clinical generalizations should be made with caution. FUNDING Novo Nordisk. CLINICALTRIALS. GOV IDENTIFIER NCT01814137.
Collapse
Affiliation(s)
| | - Louis Chaykin
- Meridien Research, 5700 E State Road 64, Bradenton, FL, 34208, USA
| | | | | |
Collapse
|
25
|
Kumar A, Franek E, Wise J, Niemeyer M, Mersebach H, Simó R. Efficacy and Safety of Once-Daily Insulin Degludec/Insulin Aspart versus Insulin Glargine (U100) for 52 Weeks in Insulin-Naïve Patients with Type 2 Diabetes: A Randomized Controlled Trial. PLoS One 2016; 11:e0163350. [PMID: 27760129 PMCID: PMC5070831 DOI: 10.1371/journal.pone.0163350] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 09/06/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose The efficacy and safety of insulin degludec/insulin aspart (IDegAsp) once daily (OD) compared with insulin glargine U100 (IGlar) OD over 52 weeks in insulin-naïve adults with type 2 diabetes mellitus (T2DM) was investigated. Methods In this open-label, parallel-group treat-to-target trial, participants were randomized (1:1) to receive IDegAsp OD (breakfast, n = 266) or IGlar OD (as per label, n = 264). Participants then entered a 26-week extension phase (IDegAsp OD, n = 192; IGlar OD, n = 221). The primary endpoint was change from baseline to Week 26 in HbA1c. Results After 26 and 52 weeks, mean HbA1c decreased to similar levels in both groups. After 52 weeks, the mean estimated treatment difference was –0.08% (–0.26, 0.09 95%CI), confirming the non-inferiority of IDegAsp OD versus IGlar OD evaluated at Week 26. After 52 weeks, there was a similar reduction in mean fasting plasma glucose in both treatment groups. The rate of confirmed hypoglycemic episodes was 86% higher (p < 0.0001) whereas the rate of nocturnal hypoglycemia was 75% lower (p < 0.0001) for IDegAsp versus IGlar. Conclusion Nocturnal-confirmed hypoglycemia was higher with IGlar whereas overall and diurnal hypoglycemia were higher with IDegAsp dosed at breakfast. These results highlight the importance of administration of IDegAsp with the main meal of the day, tailored to the individual patient’s needs. Trial Registration ClinicalTrials.gov: NCT01045707 [core]) and NCT01169766 [ext]
Collapse
Affiliation(s)
- Ajay Kumar
- Diabetes Care & Research Centre, Near Overbridge, Kankarbagh, Patna, Bihar, India
- * E-mail:
| | - Edward Franek
- Medical Research Center, Polish Academy of Sciences and Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Jonathan Wise
- Tulane Medical School, Department of Endocrinology, New Orleans, LA, United States of America
| | - Marcus Niemeyer
- Market Access and Public Affairs, Novo Nordisk Pharma GmbH, Mainz, Germany
| | - Henriette Mersebach
- Clinical Development & Research–Diabetes & Obesity, Novo Nordisk Inc, Princeton, NJ, United States of America
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Autonomous University of Barcelona, Vall d’Hebron Institute de Recerca, and CIBERDEM, Barcelona, Spain
| |
Collapse
|
26
|
Kumar A, Awata T, Bain SC, Ceriello A, Fulcher GR, Unnikrishnan AG, Arechavaleta R, Gonzalez-Gálvez G, Hirose T, Home PD, Kaku K, Litwak L, Madsbad S, Pinget M, Mehta R, Mithal A, Tambascia M, Tibaldi J, Christiansen JS. Clinical use of the co-formulation of insulin degludec and insulin aspart. Int J Clin Pract 2016; 70:657-67. [PMID: 27384031 DOI: 10.1111/ijcp.12821] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/06/2016] [Indexed: 11/28/2022] Open
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.
Collapse
Affiliation(s)
- A Kumar
- Diabetes Care & Research Centre, Patna, India
| | - T Awata
- Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan
| | - S C Bain
- Diabetes Research Unit Cymru, Swansea University & ABM University Health Board, Swansea, UK
| | - A Ceriello
- 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
- IRCCS MultiMedica, Milan, Italy
| | - G R Fulcher
- University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - R Arechavaleta
- Departamento de Endocrinologia, Universidad Autónoma de Guadalajara, Zapopan, Mexico
| | - G Gonzalez-Gálvez
- Instituto Jalisciense de Investigación en Diabetes y Obesidad S.C. Guadalajara, Jalisco, México
| | - T Hirose
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo, Japan
| | - P D Home
- Newcastle University, Newcastle upon Tyne, UK
| | - K Kaku
- Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - L Litwak
- Endocrine, Metabolism and Nuclear Medicine Service, Diabetes Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Madsbad
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Pinget
- Department of Endocrinology, University of Strasbourg, Strasbourg, France
| | - R Mehta
- Department of Endocrinology, National Institute of Medical Sciences and Nutrition, Salvador Zubirán, México City, Mexico
| | - A Mithal
- Division of Endocrinology and Diabetes, Medanta the Medicity, Gurgaon, Haryana, India
| | - M Tambascia
- Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - J Tibaldi
- Queens Diabetes and Endocrinology Associates, Fresh Meadows, New York, NY, USA
| | - J S Christiansen
- Department of Clinical Medicine - The Department of Endocrinology and Diabetes, Aarhus University Hospital, NBG, Aarhus C, Denmark
| |
Collapse
|