Abstract
Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart. The present meta-analysis was conducted to assess the efficacy and safety of IDegAsp compared with a conventional premixed insulin or basal insulin. We extracted data from citation databases, including PubMed, EMBASE, and the Cochrane Library, since inception to 2021. We calculated the mean differences for hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), self-measured mean glucose, and postprandial glucose (PPG) and odds ratios for confirmed hypoglycemia events. Compared with twice-daily conventional premixed insulin, twice-daily IDegAsp showed a similar effect on changes in HbA1c, but it significantly reduced FPG and self-measured mean glucose levels. Furthermore, compared to once-daily basal insulin, once-daily IDegAsp had a similar effect on changes in HbA1c, but it significantly reduced self-measured mean glucose and PPG levels. The risk of overall confirmed hypoglycemia was similar between treatments; however, the risk of nocturnal hypoglycemia events was significantly lower with IDegAsp than with conventional premixed insulin and basal insulin. Thus, IDegAsp was more effective than conventional premixed insulin and basal insulin at reducing blood glucose with fewer nocturnal hypoglycemia events.
Highlights
For people with type 2 diabetes (T2D) who cannot achieve optimal blood glucose levels with basal insulin and oral glucose-lowering agents, intensive treatment regimens, such as basal insulin with mealtime rapid-acting insulin regimen or premixed insulin regimens are imperative [1].Because of the development of basal insulin, such as insulin glargine (IGlr; Lantus®, a long-acting insulin analogue) and insulin degludec (IDeg, Tresiba®, an ultra-long-acting insulin analogue), the basal-bolus insulin regimen is generally used for glucose control because it more closely mimics the physiologic insulin secretion pattern compared to the premixed insulin regimen [2]
The effect on glycemic control and the risk of hypoglycemia development with those on the twice-daily Insulin degludec/insulin aspart (IDegAsp) regimen were reported in eight studies [13,14,15,16,17,18,19,20], while those on the once-daily regimen were reported in nine studies [10,21,22,23,24,25,26,27,28]
We classified one randomized controlled trials (RCTs) with a serious risk of bias as we used the data to only determine the switch from once-daily basal insulin to once-daily IDegAsp [23]
Summary
Because of the development of basal insulin, such as insulin glargine (IGlr; Lantus®, a long-acting insulin analogue) and insulin degludec (IDeg, Tresiba®, an ultra-long-acting insulin analogue), the basal-bolus insulin regimen is generally used for glucose control because it more closely mimics the physiologic insulin secretion pattern compared to the premixed insulin regimen [2]. Insulin degludec/insulin aspart (IDegAsp; Ryzodeg®) is a novel co-formulation of 70% IDeg and 30% insulin aspart (IAsp, a rapid-acting insulin) administered as a single injection, either once or twice daily with main meals [2], wherein each insulin exerts its glucose-lowering effects without establishing interactions with the other agents [5,6]
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