Science of premix insulin: where have we reached?

Diabetes is a progressive disease and by achieving and maintaining optimal glycemic control, the onset of complications can be prevented or delayed. Insulin is most effective at any stage of diabetes. Although basal-bolus therapy is the gold standard treatment, it has its own limitations such as multiple pricks, close monitoring and cost. Premixed insulin on the other hand is convenient, requires fewer injections, is a single device and delivers both the basal and bolus component till the next meal. Although premixed insulin analogs have the advantages of mealtime flexibility, compliance and better post-prandial glucose control, no significant differences have been observed in HbA1c reduction and overall hypoglycemia when compared to premixed human insulin. This review will attempt to analyze the efficacy, safety and limitations of currently available premix human insulin and premix analogs including recent advancements in the area.