Intensifying insulin therapy in type 2 diabetes mellitus: dosing options for insulin analogue premixes

As the diabetes epidemic expands, health care providers need more options to achieve glycemic control. Insulin analogue premixes provide basal and prandial insulin with 1 injection.

The aim of this review was to provide an overview of the efficacy and tolerability of insulin analogue premixes in patients with type 2 diabetes mellitus (T2DM).

Sources of information for the present review included guidelines from the American Association of Clinical Endocrinologists, the American Diabetes Association (ADA), and the European Association for the Study of Diabetes. A PubMed search of clinical trials that have assessed the efficacy and tolerability of insulin lispro, biphasic insulin aspart, biphasic human insulin, insulin analogue premix, insulin glargine, insulin detemir, and neutral protamine Hagedorn, as well as the Oxford Centre for Evidence-Based Medicine grades of recommendation and ADA levels of evidence, were employed.

Of the 240 articles identified, 19 presented relevant clinical trial data. Biphasic insulin analogues have been associated with changes in hemoglobin A(1c), including aspart 70/30 (BIAsp 30) (changes, -1.23% to -2.89%), lispro mix 75/25 (-1.8%), and lispro mix 50/50 (-1.87%). Hypoglycemic events were reported in 18%, 23% to 42%, and 32% to 40% of patients who received BIAsp 30, lispro 75/25, and lispro 50/50, respectively. In some studies, algorithms were used for ensuring correct doses of BIAsp 30 and lispro mix 75/25. These algorithms were reported to be useful for guiding patients and physicians when more intense therapy with biphasic insulin analogues was required for effective glycemic control.

Based on the findings from the present review, health care providers may improve patient care by using the most appropriate insulin type and individualizing dosing regimens. The initiation of treatment with biphasic insulin analogue premixes should be considered when basal insulin therapy alone is not sufficient to obtain optimal glycemic control.