 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||
|
|||||||||||
Clinical Associate Professor of Internal Medicine University of Texas Southwestern Medical School Dallas, Texas Endocrine & Diabetes Associates of Texas 7777 Forest, Suite C204 Dallas, Texas 75230-2505 fax 972/566-7943 endodiab{at}medicalcitydallas.com
Published Online, April 5, 2005. www.theannals.com, DOI 10.1345/aph.1D635a
The article states that "premixed insulins are not recommended until after a patient's insulin requirements are determined because they limit the patient's ability to alter the dose of either insulin." I disagree with this statement. Premixed insulin, particularly premix analogs, such as biphasic insulin aspart 30 (BIAsp 30) and biphasic insulin lispro 25 (Mix 25), are accepted by many specialists as a suitable and successful starter insulin for patients with type 2 diabetes.
For successful treatment of type 2 diabetes mellitus, patients should be treated to target. Indeed, glycemic targets set by leading diabetes authorities, including the American College of Endocrinologists, the International Diabetes Federation, and the American Diabetes Association, not only include preprandial glucose targets, but also postprandial glucose goals.2 Although some patients may achieve both of these targets while receiving 1 or 2 injections of basal insulin per day, others require insulin that targets both pre- and postprandial levels.
The rationale behind developing premixes is based on this very principle. The prandial insulin response is often blunted in people with type 2 diabetes3; premix analog preparations comprise a rapid-acting component that targets postprandial glucose excursions, thus addressing this deficit. The remaining portion of the premix preparation is made up of protaminated insulin analog, which acts as a longer-acting insulin that can address basal insulin needs. Thus, the 2 components of the premix analog—soluble (free) and protaminated—are able to provide insulin that aims to control both postprandial and fasting-plasma glucose in one convenient injection, often given twice daily.
The success of premix analogs in achieving glycemic control in insulin-naïve patients with type 2 diabetes is supported by reported clinical trials. Raskin et al.4 studied patients with type 2 diabetes who failed to achieve glycemic control with oral agents. They were treated with either twice-daily BIAsp 30 for 28 weeks, showing a reduction in glycosylated hemoglobin (HbA1c) of –2.8%, or a basal regimen with glargine insulin once daily. Sixty-six percent of the BIAsp 30 group and 42% of patients in the glargine group achieved HbA1c targets of <7% and <6.5%, respectively.
Premix analogs have also been shown to provide better control when compared with a once-daily long-acting insulin analog, such as insulin glargine, which is widely used as a starter insulin in patients with type 2 diabetes who are poorly controlled on oral treatments.4,5 Indeed, evidence suggests that a once-daily injection of a long-acting insulin may not be the most physiologic treatment option available to treat the insulin deficits seen in type 2 diabetes.6
In conclusion, the premix analogs are a useful addition to the currently available treatments for initiating insulin in patients with type 2 diabetes. Furthermore, they should always be considered by physicians and patients alongside the other treatments available at this important juncture in the management of type 2 diabetes.
Footnotes
The author has been involved in research studies for Amylin, Eli Lilly & Co., Sanofi-Aventis, Novartis Pharmaceuticals, SmithKline Beecham Pharmaceuticals, Novo Nordisk Pharmaceutical, and Myogen. He is a consultant and/or member of the speakers bureaus for Bristol Myers Squibb, Eli Lilly & Co., Sanofi-Aventis, Pfizer Pharmaceuticals, Novo Nordisk Pharmaceutical, SmithKline Beecham Pharmaceuticals, Takeda, Novartis Pharmaceuticals, and Roche.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
 |
