IntroductionPremix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and switching from basal–bolus to a premix insulin analog when appropriate.MethodsAn independent expert panel formulated recommendations on the use in T2D of the premix insulin analog formulations widely available in Australasia, based on the available evidence and their own experience.ResultsResults from trials in both initiation and intensification of insulin show that no single insulin or regimen is best on all endpoints, and that improved glycemic control can be expected regardless of which regimen is used. Thus, individual patient factors and preferences become more important. Guidance is presented to help the clinician choose between a premix insulin analog or basal analog for insulin initiation, and to intensify insulin therapy using premix insulin analogs. Recommendations are made on dosing, titration, the concomitant use of non-insulin glucose-lowering drugs, and other practical issues, and on the special case of switching from basal–bolus to premix insulin analog therapy.ConclusionThis guidance is intended to help both general and specialist practitioners make informed choices and provide optimal care for patients with T2D. It emphasizes the importance of taking into account individual patient factors and preferences so that the choice of insulin regimen is individualized to the patient in the same way that glycemic targets are now individualized.FundingNovo Nordisk Region IO A/S.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-015-0116-0) contains supplementary material, which is available to authorized users.

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.

SummaryIs obesity a disease? Much ink has been spilled over this debate and for good reasons. The global prevalence of obesity has more than doubled since the 1980s and is now of pandemic proportions. Whether obesity is a disease has consequences for what kind of treatments are appropriate, as well as how we ought to allocate funding and access to healthcare resources. In most cases, there is no dispute over the medical facts, yet disagreement persists. This is because whether obesity is a disease is not determined by medical facts alone; the issue is, in part, conceptual. Science relies on careful argumentation and conceptual analysis as part of its armamentarium. In this review, we will examine the two concepts of disease most often employed in the philosophy of medicine: the naturalistic and constructivist. We will argue that, whichever definition of a disease is used, obesity fits the criteria for disease definition. Those seeking to meet the challenge of managing obesity will, therefore, need to embrace chronic disease models of care suited to addressing the lifelong challenge posed by this disease and its associated complications.