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3 . 2021

It's time to change stereotypes: a new look at fixed-mixtures insulins

Abstract

Insulin therapy is widely used today in the treatment of patients with both type 1 and type 2 diabetes, and there is a huge variety of dosage forms of insulin for the selection of the most individualized treatment regimen. Treatment regimens are often complex, require a combination of several drugs, which Leads to both a decrease in adherence to treatment and errors, and simply refusal of insulin therapy. In order to simplify the treatment regimen and reduce the number of injections, combined insulin consisting of prandial and basal components were created. Until recently all the drugs used had significant drawbacks: they required resuspending, administration for a long time before meals, and were also accompanied by a high risk of hypoglycemia. Today, a fundamentally new drug IDeg/Asp (Risodeg®) combining the basal insulin - ultra-long-acting degludek (70%) and the insulin analogue of the ultrashort-acting aspart (30%) has appeared. The properties of the components that make up the drug relieve it from the disadvantages of previously used combined insulins and give maximum safety and flexibility of use.

Keywords:insulin therapy, combined insulin, insulin analogues, hypoglycemia, IDeg/Asp (Risodeg®), flexibility of use

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Pashkova E.Yu., Gezalyan M.A. It's time to change stereotypes: a new look at fixed-mixtures insulins. Endokri-nologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2021; 10 (3): 59-65. DOI: https://doi.org/10.33029/2304-9529-2021-10-3-59-65 (in Russian)

REFERENCES

1. World Health Organization. Global report on diabetes. 2018. (date of access June 21, 2018)

2. International Diabetes Federation. IDF diabetes atlas. 8th ed. 2017. URL: http://www.diabetesatlas.org/across-the-globe.html (date of access June 21, 2018)

3. Fehse F., Trautmann M., Holst J.J., Halseth A.E., Nanayakkara N., Nielsen L.L., et al. Xenatide augments first- and second-phase insulin secretion in response to intravenous glucose in subjects with type 2 diabetes. J Clin Endocrinol Metab. 2005; 90: 5991-7.

4. Meneghini L. New insulin preparations: a primer for the clinician. Cleve Clin J Med. 2016; 83 (5 suppl 1): S27-33.

5. Sanjay K., et al. Expert opinion: patient selection for premixed insulin formulations in diabetes care. Diabetes Ther. 2018; 9: 2185-99.

6. Harris S.B., Kapor J., Lank C.N., Willan A.R., Houston T. Clinical inertia in patients with T2DM requiring insulin in family practice. Can Fam Physician. 2010; 56: e418-24.

7. Dale J., Martin S., Gadsby R. Insulin initiation in primary care for patients with type 2 diabetes: 3-year follow-up study. Prim Care Diabetes. 2010; 4: 85-9.

8. Khunti K., Millar-Jones D. Clinical inertia to insulin initiation and intensification in the UK: a focused literature review. Prim Care Diabetes. 2017; 11: 3-12.

9. Billings L.K., et al. Efficacy and safety of IDegLira versus basal-bolus insulin therapy in patients with type 2 diabetes uncontrolled on metformin and basal insulin; DUAL VII randomized clinical trial. Diabetes Care. 2018; 41 (5): 1009-16.

10. Seaquist E.R., Anderson J., Childs B., et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013; 36: 1384-95.

11. Wenying Yang, et al. Efficacy and safety of insulin degludec/insulin aspart versus biphasic insulin aspart 30 in Chinese adults with type 2 diabetes: a phase III, open-label, 2:1 randomized, treat-to-target trial. Diabetes Obes Metab. 2019; 21: 1652-60.

12. Tevfik D., et al. Use of insulin degludec/insulin aspart in the management of diabetes mellitus: expert panel recommendations on appropriate practice patterns. Front Endocrinol. 2021; 12: 616514.

13. Havelund S., Ribel U., Hubalek F., Hoeg-Jensen T., Wahlund P.O., Jonassen I. Investigation of the physico-chemical properties that enable coformulation of basal insulin degludec with fast-acting insulin aspart. Pharm Res. 2015; 32: 2250-8. DOI: https://doi.org/10.1007/s11095-014-1614-x

14. Unnikrishnan A.G., Singh A.K., Modi K.D., Saboo B., Garcha S.C., Rao P.V. Review of clinical profile of IDegAsp. J Assoc Physicians India. 2015; 63: 15-20.

15. Haahr H., Fita E.G., Heise T. A review of insulin degludec/insulin aspart: pharmacokinetic and pharmacodynamic properties and their implications in clinical use. Clin Pharmacokinet. 2017; 56: 339-54. DOI: https://doi.org/10.1007/s40262-016-0455-7

16. Vaag A., Lund S.S. Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues. Eur J Endocrinol. 2012; 166: 159-70. DOI: https://doi.org/10.1530/EJE-11-0022

17. Dedov I.I., Shestakova M.V. Insulin degludec/insulin aspart is the first coformulation of basal and prandial insulin analogues. Sakharniy diabet [Diabetes Mellitus]. 2014; (4): 108-19. (in Russian)

18. Heise T., Tack C.J., Cuddihy R., et al. A new-generation ultra-long-acting basal insulin with a bolus boost compared with insulin glargine in insulin-naive people with type 2 diabetes: a randomized, controlled trial. Diabetes Care. 2011; 34 (3): 669-74.

19. Hirsch I.B., Franek E., Mersebach H., et al. Safety and efficacy of insulin degludec/insulin aspart with bolus mealtime insulin aspart compared with standard basal-bolus treatment in people with type 1 diabetes: 1-year results from a randomized clinical trial (BOOST® T1). Diabet Med. 2017; 34 (2): 167-73.

20. Christiansen J.S., Niskanen L., Rasmussen S., et al. Lower rates of hypoglycemia during maintenance treatment with insulin degludec/insulin aspart versus biphasic insulin aspart 30: a combined analysis of two phase 3a studies in type 2 diabetes. J Diabetes. 2016; 8 (5): 720-8.

21. Hassanein M., Echtay A.S., Malek R., et al. Original paper: efficacy and safety analysis of insulin degludec/insulin aspart compared with biphasic insulin aspart 30: a phase 3, multicentre, international, open-label, randomised, treat-to-target trial in patients with type 2 diabetes fasting during. Diabetes Res Clin Pract. 2018; 135: 218-26.

22. Fulcher G., Mehta R., Fita E.G., et al. Efficacy and safety of IDegAsp versus BIAsp 30, both twice daily, in elderly patients with type 2 diabetes: post hoc analysis of two phase 3 randomized controlled BOOST trials. Diabetes Ther. 2019; 10 (1): 107-18.

23. Dedov I.I., Shestakova M.V., Mayorov A.Yu., et al. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition. Sakharniy diabet [Diabetes Mellitus]. 2019; 22 (1S1): 144 p. (in Russian)

24. Shestakova M.V., Surkova E.V., Vachugova A.A., et al. The first and only combination of basal and prandial insulin analogs degludec and aspart: the position of Russian endocrinologists. Sakharniy diabet [Diabetes Mellitus]. 2021; 24 (2): 175-84. (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
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