Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care

Kalra, Sanjay; Czupryniak, Leszek; Kilov, Gary; Lamptey, Roberta; Kumar, Ajay; Unnikrishnan, Ambika Gopalakrishnan; Boudiba, A.; Abid, M.; Akanov, Zhanay; Latheef, Ali; Araz, Mustafa; Audehm, Ralph; Bahendeka, Silver; Baldé, N.M.; Chaudhary, Sandeep; Deerochanawong, Chaicharn; Fasanmade, O.A; Iraqi, H.; Latt, Tint Swe; Mbanya, Jean Claude; Rodriguez-Saldana, Joel; Hyun, Ko Seung; Latif, Zafar Ahmed; Lushchyk, Maxim; Megallaa, Magdy Helmy; Naseri, Mohammed Wali; Bay, Nguyen Quang; Ramaiya, Kaushik; Randeree, Hoosen; Raza, Syed Abbas; Shaikh, Khalid; Shrestha, Dina; Sobngwi, Eugène; Somasundaram, Noel; Sukor, Norlela; Tan, Rima

doi:10.1007/s13300-018-0521-2

Cited by 29 publications

(21 citation statements)

References 44 publications

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“…A search string ''insulin therapy'' ? ''Africa'' generated 56 The Health Action International and International Diabetes Federation (IDF) websites were also searched for relevant information. In cases where there were divergent views on any salient matter, a vote was called among the experts and a simple majority was deemed acceptable for a decision to be reached.…”

Section: Search Strategymentioning

confidence: 99%

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African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus

et al. 2020

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The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increasing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treatment with the appropriate type of insulin based on the meal patterns and lifestyle of the individual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient’s habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.

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Section: Search Strategymentioning

confidence: 99%

“…Glycaemic index of commonly consumed food in sub-Saharan AfricaLow GI foods (GI £ 55)Medium GI foods(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) High GI foods (> 70)…”

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African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus

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“…Most of these adjustments are to be carried out 10-14 days after arrival in the home countries so that there is a more accurate reflection of the metabolic milieu. Most patients require an increase in antidiabetic medication to match the reduced physical activity, more optimal environment and increased dietary consumption [45].…”

Section: Post-hajj Managementmentioning

confidence: 99%

“… Insulin analogues, such as insulin degludec and insulin aspart, are superior medications for the management of unexpected blood glucose changes due to erratic dietary patterns during Hajj, and thus are preferred [ 45 ]. …”

Section: Management During Hajjmentioning

confidence: 99%

Diabetes Care During Hajj

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Diabetes mellitus affects over 463 million individuals worldwide. Religious activities such as the Hajj pilgrimage have a major impact on patients with diabetes mellitus, including increasing the risk of hyperglycaemia and hypoglycaemia. This increased risk is due to dietary changes and intense physical activity during pilgrimage while being on antidiabetic medications. Approximately 20% of the pilgrims with underlying illnesses who visit Mecca are diabetic, and complications, such as diabetic ketoacidosis, nonketotic hyperosmolar state, and fatigue/unconsciousness due to hypoglycaemia, have been observed among these patients. Diabetic patients are also at a high risk for foot complications and infections. To avoid any aggravation of the diabetes, a complete biochemical evaluation of the patient must be conducted before Hajj, and the patients must be provided contextualized educational guidance to avert these potential health challenges. This counselling should include the importance of

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“…Premixed insulin analogues are an optional choice for patients with type 2 diabetes (T2D) to maintain their blood glucose concentrations in the target range [1]. Although no guidelines recommended for initiation or intensification of premixed insulin analogues, patients who received basal insulin regimen and failed to achieving glycemic control can benefit from thrice-daily premixed insulin analogue intensified therapy for a 24-week treatment [2].…”

Section: Introductionmentioning

confidence: 99%

Sexual Differences in response to Mid- or Low-Premixed Insulin Analogue in Patients with Type 2 Diabetes

Liu

Ren

et al. 2020

Journal of Diabetes Research

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Objective. To observe whether there are sexual-related differences in response to mid- or low-premixed insulin in type 2 diabetic patients. Methods. This was an analysis of CGM data of a previous study. After screening, patients with longstanding T2D receive a 7-day continuous subcutaneous insulin infusion (CSII) therapy, and then subjects were randomly assigned 1 : 1 into two groups receiving Novo Mix 30 or Humalog Mix 50 regimen for a 2-day phage, followed by a 4-day cross-over period. A 4-day continuous glucose monitoring (CGM) was performed during the cross-over period. The primary endpoint was the differences in glycemic control between male and female patients receiving mid- or low-premixed insulin therapy. Results. A total of 102 patients (52 men and 50 women) completed the study. Our data showed that male patients had significant decrease in mean glucose levels monitored by CGM after three meals during Humalog Mix 50 treatment period compared to those received Novo Mix 30 regimen (0900: 11.0±2.5 vs. 12.2±2.8, 1000: 9.9±2.9 vs. 11.3±3.1, 1200: 8.0±1.9 vs. 9.1±2.5, 1400: 9.2±2.3 vs. 10.3±2.5, and 2000: 7.3±2.1 vs. 8.2±2.4 mmol/L, p<0.05, respectively). In addition, male patients receiving Novo Mix 30 experienced a significantly increased hypoglycemic duration compared to those of receiving Humalog Mix 50 (0 (0, 4.8) vs. 0 (0, 0), p<0.05). Conclusion. Our data indicate that male patients with T2D receiving mid-premixed insulin analogue regimen may have a potential benefit of improvement in glycemic control compared to female patients. This trial is registered with ClinicalTrials.gov ChiCTR-IPR-15007340.

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Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care

Cited by 29 publications

References 44 publications

African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus

African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus

Diabetes Care During Hajj

Sexual Differences in response to Mid- or Low-Premixed Insulin Analogue in Patients with Type 2 Diabetes

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