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.
Highlights
In accordance with worldwide trends for rapidly increasing prevalence of diabetes, it is estimated that 700 million people will be affected by diabetes 2045 [1]
The proposed expert opinion planned to provide a practical and implementable guidance document addressing the appropriate use of Insulin degludec/insulin aspart (IDegAsp) in the management of diabetes in terms of (a) IDegAsp-based freedom and flexibility in diabetes care, b) the main meal concept c) use of IDegAsp in pediatric and adult type 2 diabetes (T2D) patients, d) use of IDegAsp in type 1 diabetes (T1D) patients, e) use of IDegAsp in pregnancy and f) use of IDegAsp in special patient groups
In a phase 3, 26-week, open-label, treat-to-target trial in insulin-naïve adults with T2D randomized to once-daily injections of IDegAsp (n = 147) or insulin glargine (IGlar) (n = 149), both ±≤2 oral antidiabetic drugs (OADs), IDegAsp was reported to be associated with superior long-term glycemic control than IGlar (HbA1c: 7.0 vs. 7.3%; HbA1c
Summary
In accordance with worldwide trends for rapidly increasing prevalence of diabetes, it is estimated that 700 million people will be affected by diabetes 2045 [1]. Data from DROPOUT studies (n = 433 and n = 1,456) [25, 26] in insulin-naive type 2 diabetes patients in Turkey revealed association of premixed insulin treatment with better patient compliance compared to basalbolus treatment in terms of dose-skipping (19 vs 52%) and not using insulin for more than a day (22.7 and 61.3%) [25], while in terms of higher treatment adherence (75 vs 62.8%) compared to basal insulin [26]. There is a need for guidance document to assist clinicians in using this novel insulin regimen with unique pharmacological properties in real-life clinical practice in terms of dose timing relative to meal(s), daily dosage, treatment intensification or switching from previous antidiabetic therapy as well as different patient populations (adult, children, T1D, T2D, pregnant, elderly, hospitalized).
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