Multinational Consensus: Insulin Initiation with Insulin Degludec/Aspart (IDegAsp)

Kalra, Sanjay; Atkin, Stephen L.; Cervera, Antonio; Das, Ashok Kumar; Demir, Özgür; Demir, Tevfik; Fariduddin, .; Vo, Khoa Tuan; Ku, Bon Jeong; Kumar, Ajay; Latif, ZA; Malek, R.; Matawaran, Bien J.; Mehta, Roopa; Tran, Nam Quang; Panelo, Araceli; Ruder, Sundeep; Saldana, Joel Rodriquez; Shaikh, Khalid; Shakya, Amit; Shrestha, Dina; Unnikrishnan, Ambika Gopalakrishnan

doi:10.1007/s12325-018-0712-2

Cited by 8 publications

(18 citation statements)

References 16 publications

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“…27 The flexibility in dose timing of IDegAsp allows the main meal to be eaten at any time during the day. 10,32 However, if a dose is missed, it should be taken with the next main meal of that day; an extra dose should not be taken at any other time to compensate for a missed dose. 10 After the missed dose is taken, the usual dosing schedule should be resumed.…”

Section: Main Meal Conceptmentioning

confidence: 99%

Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines

Mehta

Chen

Hirose

et al. 2020

Diabetes Obesity Metabolism

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Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec, which provides long-lasting basal insulin coverage, and insulin aspart, which targets postprandial glycaemia. This review provides expert opinion on the practical clinical use of IDegAsp, including: dose timings relative to meals, when and how to intensify treatment from once-daily (OD) to twice-daily (BID) dose adjustments, and use in special populations (including hospitalized patients). IDegAsp could be considered as one among the choices for initiating insulin treatment, preferential to starting on basal insulin alone, particularly for people with severe hyperglycaemia and/or when postprandial hyperglycaemia is a major concern. The recommended starting dose of IDegAsp is 10 units with the most carbohydrate-rich meal(s), followed by individualized dose adjustments. Insulin doses should be titrated once weekly in two-unit steps, guided by individualized fasting plasma glucose targets and based on patient goals, preferences and hypoglycaemia risk. Options for intensification from IDegAsp OD are discussed, which should be guided by HbA1c, prandial glucose levels, meal patterns and patient preferences. Recommendations for

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Section: Main Meal Conceptmentioning

confidence: 99%

Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines

Mehta

Chen

Hirose

et al. 2020

Diabetes Obesity Metabolism

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“…[30,40] Therefore, the rapid-acting analogue advantage at mealtimes is retained, combined with truly flat 24 h basal profile of insulin degludec, decreased variability after injection and no 'shoulder effect' after meals, as would be the case with premixed insulins. The IDegAsp co-formulation provides both FPG and PPG control, and allows flexibility in the timing of dosing (e.g., for people travelling across time zones, shift workers or those who rely on healthcare providers to administer their insulin during home visits) in a simple regimen with fewer injections than basal-bolus regimens and a lower rate of hypoglycaemia than premix, basal-plus or basal-bolus regimens [41][42][43]. Moreover, due to the co-formulation, there is no need to gently mix the insulins prior to injection.…”

Section: The Idegasp Co-formulationmentioning

confidence: 99%

“…IDegAsp may be considered for initiation of insulin in people with T2D following an inadequate response to OADs (Figure 3) and is preferable to basal insulin alone when prandial glucose control is required [42,44].…”

Section: Initiation Of Idegasp In Insulin-naïve People With T2dmentioning

confidence: 99%

“…Variability in dietary patterns and practices (e.g., low carbohydrate, ketogenic diet or intermittent fasting), an erratic lifestyle with variability of meal choice and timing, illness or religious practices such as Ramadan can influence glycaemic control in people with diabetes [61]. IDegAsp may be useful in these situations due to flexibility in the dosing schedule [42], though its use should be cautioned in some instances, particularly if carbohydrate ingestion is limited at the meal with which IDegAsp is injected.…”

Section: Patients On a Very-low-calorie Reduced-carbohydrate Or Erramentioning

confidence: 99%

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The Clinical Role of Insulin Degludec/Insulin Aspart in Type 2 Diabetes: An Empirical Perspective from Experience in Australia

Glastras

Cohen

Dover

et al. 2020

JCM

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Treatment intensification in people with type 2 diabetes following failure of basal insulin commonly involves the addition of a rapid-acting insulin analogue (basal plus one or more prandial doses; multiple daily injections) or by a switch to premixed insulin. Insulin degludec/insulin aspart (IDegAsp), comprising rapid-acting insulin aspart and ultra-long-acting insulin degludec in solution, enables both fasting and post-prandial glucose control, with some advantages over other treatment intensification options. These include straightforward dose titration, flexibility in dose timing, low injection burden, simplicity of switching and a lower risk of hypoglycaemia. In Australia, where insulin degludec on its own is not available, IDegAsp enables patients to still benefit from its ultra-long-acting properties. This review aims to provide guidance on where and how to use IDegAsp. Specifically, guidance is included on the initiation of IDegAsp in insulin-naïve patients, treatment intensification from basal insulin, switching from premixed or basal-bolus insulin to IDegAsp, up-titration from once- to twice-daily IDegAsp and the use of IDegAsp in special populations or situations.

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“…According to a multinational consensus group, IDegAsp is a good preparation for initiation of insulin therapy in the following: drug-naıve patients with symptoms of hyperglycemia, patients on a high carbohydrate diet, patients with high HbA1c levels, and postprandial excursions. It can also be used to initiate therapy following failure of (single, dual, or triple) oral anti-diabeteic agents [ 38 ].…”

Section: Factors Influencing Choice Of Premixed Formulationsmentioning

confidence: 99%

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

et al. 2018

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Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a ‘glucocentric’ approach to a ‘patient-centered’ approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.

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Multinational Consensus: Insulin Initiation with Insulin Degludec/Aspart (IDegAsp)

Cited by 8 publications

References 16 publications

Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines

Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines

The Clinical Role of Insulin Degludec/Insulin Aspart in Type 2 Diabetes: An Empirical Perspective from Experience in Australia

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

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