Biphasic insulin aspart in the treatment of type 2 diabetes mellitus

Initiating and implementing insulin treatment in type 2 diabetic subjects is a major challenge in diabetes clinical practice. Although simple regimens, such as the combination of a once-daily basal insulin + oral agents, are widely used, they often are not able to achieve an adequate glycemic control, especially in the postprandial period. Biphasic insulin analogues are a valid tool to start and to improve insulin treatment in type 2 diabetes. Biphasic insulin aspart (BIAsp) is available in three different mixtures (30, 50 and 70% of rapid-acting insulin, respectively), which allows insulin treatment to be individualized.

To review recent published papers concerning pharmacological properties and clinical use of BIAsp in type 2 diabetes.

BIAsp seems to have some advantages over biphasic human insulins, especially for its practical pre- or post-meal administration and lesser hypoglycemic risk. Against basal insulins once daily, BIAsp twice daily seems to perform better in achieving the glucose targets and, even when compared with the more complex basal-bolus regimens, a BIAsp-based treatment using the different available mixtures is at least non-inferior. Side effects are no more frequent than with other insulins; more hypoglycemic episodes of low severity have been sometimes reported, but only in comparison with basal insulin.