Premixed insulin regimens in type 2 diabetes: pros

Endocrine. 2017 Jan;55(1):45-50. doi: 10.1007/s12020-016-0917-6. Epub 2016 Mar 22.

Abstract

Because of the increasing prevalence of type 2 diabetes, the need to intensify treatment to manage hyperglycemia is expanding. Premixed insulin regimens were designed to maximize patient convenience and reduce the number of daily injections required by providing both rapid-acting and intermediate-acting components in one formulation. Although the basal bolus insulin regimen is considered by many as "the golden standard" in reaching goals of glycemic control, proper use of intensified insulin regimens, such as basal bolus or premixed, will result in similar HbA1c reduction, hypoglycemic events, and weight gain. At the same number of daily insulin injections (2 shots/day), the premixed regimen is associated with a significant 0.2 % HbA1c decrease, as compared with the basal plus regimen (one shot of long-acting plus one shot of short-acting insulin). The choice of insulin regimen should consider the preferences, and resources of the individual and the family for adapting treatment to the patient needs. At last, the process of insulin initiation and intensification in type 2 diabetes must be carried out in the context of patient safety, minimizing the risk of hypoglycemia, weight gain, and injection burden.

Keywords: Basal bolus insulin regimen; Basal plus insulin regimen; Premixed insulin regimen; Type 2 diabetes.

MeSH terms

  • Adult
  • Biphasic Insulins / administration & dosage
  • Biphasic Insulins / adverse effects
  • Biphasic Insulins / therapeutic use*
  • Cost of Illness
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Drug Administration Schedule
  • Drug Monitoring
  • Evidence-Based Medicine*
  • Glycated Hemoglobin A / analysis
  • Health Transition
  • Humans
  • Hyperglycemia / prevention & control*
  • Hypoglycemia / chemically induced
  • Hypoglycemia / prevention & control*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Patient Preference
  • Practice Guidelines as Topic
  • Precision Medicine*
  • United States / epidemiology
  • Weight Gain / drug effects

Substances

  • Biphasic Insulins
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human