Efficacy and Safety of Insulin Degludec/Insulin Aspart (IDegAsp) in Type 2 Diabetes: Systematic Review and Meta-Analysis

Abstract

Type 2 diabetes mellitus is a prevalent metabolic disease requiring tight glycemic control of basal and postprandial glucose levels. Treatment intensification using separate basal and bolus injections increased the number of injections and reduced cost-effectivity, leading to decreased compliance and failure of glycemic control. Insulin Degludec/Insulin Aspart (IDegAsp), a novel premix of basal and bolus insulin, is one of the potential treatments for reducing the number of injections. However, its efficacy and safety have not been reviewed clearly. Therefore, this systematic review aims to compare the efficacy and safety of IDegAsp with standard basal and basal plus bolus insulin regimens.A systematic review of four databases (Pubmed, Scopus, Science Direct, and Proquest) was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Search results were screened by eligibility criteria and critically appraised by the Oxford Centre for Evidence-Based Medicine (CEBM) tool and the Cochrane risk-of-bias assessment tool. Meta-Analysis was done using Review Manager to obtain cumulative outcomes from hemoglobin A1C (HbA1C) changes, hypoglycemia incidents, and weight gain from all studies.Out of 132 search results, 10 studies were reviewed. IDegAsp once-daily administration was proven beneficial in reducing HbA1c levels and nocturnal hypoglycemia incidences, while IDegAsp twice-daily administration was proven beneficial in lowering hypoglycemia incidence and nocturnal hypoglycemia incidence. IDegAsp yielded better glycemic index results and lowered hypoglycemic incidents in the metaanalysis.Thus, it is concluded that IDegAsp once daily with stepwise titration on the largest meal of the day achieved most benefits with minimal risks.

Efficacy and Safety of Insulin Degludec/Insulin Aspart versus Biphasic Insulin Aspart 30 in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials

“…IDegAsp can effectively simulate insulin secretion in the body; regulate FPG and postprandial blood sugar. Studies showed that IDegAsp could be an optimal treatment option for T2D patients with poor blood sugar control (22)(23)(24). Our meta-analysis found that compared to BIAsp30, IDegAsp could better control FPG and significantly reduce the endpoint daily insulin dosage, while having no significant impact on body weight and HbA1c.…”

Observation of the Clinical Efficacy and Safety of degludec/insulin aspart Combined with Metformin in Type 2 Diabetes Patients with Poor Blood Sugar Control.

“…Hypoglycemia is an important issue to consider in insulin treatment for diabetes, and relevant studies have shown that twice-daily administration of IDegAsp is bene cial in reducing the occurrence rate of hypoglycemia and nocturnal hypoglycemia. [11] The results of this experiment found that the use of IDegAsp combined with metformin in type 2 diabetes patients with poor blood sugar control had a lower hypoglycemia risk compared to Insulin aspart 30 combined with metformin, but this difference was not statistically signi cant. The reduced hypoglycemia risk may be to the ultra-long-acting and stable release of the basal insulin component in the body.…”

Various insulin delivery systems for management of diabetes mellitus

“…In this type the amino acid B28 (proline) is substituted with aspartic acid thus, reducing self-association of the molecule and avoid forming any hexamers [18,19]. When given intravenously, it had a safety profile very close to that of human insulin.…”

“…It is an ultra-long-acting insulin formed from omitting the B30 amino acid and linking a glutamic acid spacer which links a 16carbon fatty di-acid chain to the B29 amino acid [18,25]. After subcutaneous injection it forms soluble multi-hexamers releasing insulin monomers slowly into the bloodstream, thus providing a prolonged duration of action and can be injected only three times a week.…”