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Injectable combination therapies for the management of diabetes: an Indian perspective

Deep Dutta1, Deepak Khandelwal2, Sanjay Kalra3

  • 1Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspecialty Clinics, Dwarka, New Delhi, India.

Expert Opinion on Drug Metabolism & Toxicology
|February 27, 2020
PubMed

Introduction: This review focuses on currently available injectable combination therapies (ICTs) for managing diabetes.Areas covered: References were identified through searches of PubMed, Medline, and Embase for articles published till July 2019 using terms 'insulin' [MeSH Terms] OR 'glucagon like peptide 1 analogue' [All Fields] OR 'combination therapy' [All Fields] 'combination insulin therapy' [All Fields] OR 'combination GLP1 analogue therapy' [All Fields] OR 'premixed insulin' [All Fields].Expert opinion: Currently, there are nine types of ICTs for diabetes available. ICTs are classified on the basis of whether they are combinations of conventional human insulin, human insulin analogs, insulin coformulations, and insulin glucagon-like peptide-1 receptor agonists (GLP-1RA) and have a subtle difference in pharmacokinetic and pharmacodynamic properties. ICTs have been consistently demonstrated to play a major role in improving glycemic control. In a different meta-analysis involving patients assessed for glycemic control as the primary endpoint, no significant difference was noted with regard to HbA1c reduction, hypoglycemia, weight change, and daily insulin dose in patients on basal-bolus regimen, as compared to ICTs. All international guidelines recommend ICTs for treatment intensification.ICTs provide more flexibility to the treating doctor in fine-tuning the insulin/GLP-1RA regimen and have the advantages of reducing daily needle-prick count and better long-term compliance.

Keywords:
Insulin therapyhypoglycemiainsulin regimenpremixed insulin

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