Efficacy and safety of biphasic insulin aspart and biphasic insulin lispro mix in patients with type 2 diabetes: A review of the literature

Abstract

Type 2 diabetes (T2D) represents an escalating burden worldwide, particularly in China and India. Compared with Caucasians, Asian people with diabetes have lower body mass index, increased visceral adiposity, and postprandial glucose (PPG)/insulin resistance. Since postprandial hyperglycemia contributes significantly to total glycemic burden and is associated with heightened cardiovascular risk, targeting PPG early in T2D is paramount. Premixed insulin regimens are widely used in Asia due to their convenience and effectiveness. Data from randomized controlled trials and observational studies comparing efficacy and safety of biphasic insulin aspart 30 (BIAsp 30) with biphasic insulin lispro mix (LM 25/50) and versus other insulin therapies or oral antidiabetic drugs (OADs) in T2D demonstrated that BIAsp 30 and LM 25/50 were associated with similar or greater improvements in glycemic control versus comparator regimens, such as basal–bolus insulin, in insulin-naÏve, and prior insulin users. Studies directly comparing BIAsp 30 and LM 25 provided conflicting glycemic control results. Safety data generally showed increased hypoglycemia and weight gain with premixed insulins versus basal–bolus insulin or OADs. However, large observational trials documented improvements in glycated hemoglobin, PPG, and hypoglycemia with BIAsp 30 in multi-ethnic patient populations. In summary, this literature review demonstrates that premixed insulin regimens are an appropriate and effective treatment choice in T2D.

Indirect comparison of efficacy and safety of insulin glargine/lixisenatide and insulin degludec/insulin aspart in type 2 diabetes patients not controlled on basal insulin

“…The present indirect comparison between IDegAsp and IGlarLixi proposed a protective effect of the latter against weight gain. This observation is consistent with the literature [13,15,16], where IGlarLixi was not associated with weight gain, in contrast with fast-acting insulin combined with long-acting insulin [16][17][18]. In addition, gastrointestinal adverse effects reported with lixisenatide alone were alleviated in patients treated with IGlarLixi [15], further supporting the use of the combination formula.…”

Discordance between fasting plasma glucose and A1c in the diagnosis and management of diabetes

“… Metformin reduces glucose production during the fasting state, while improves glucose use, which may not be the main postprandial factor; however, studies have shown that using Metformin and Glyburide reduces glucose levels after meals.  α-Glucosidase inhibitors reduce digestion and absorption of carbohydrates, lowering glucose levels after meals by 0.5%, but patients may have gastrointestinal side effects [75,76,77,80].  Amylin analog decreases postprandial blood glucose by glucagon suppression and delays gastric emptying time [78].…”

“… Amylin analog decreases postprandial blood glucose by glucagon suppression and delays gastric emptying time [78].  Short-acting insulin [79] and rapid-acting insulin analog or premix insulin [80,81].  GLP-1 is a hormone secreted by intestinal L cells after eating, which increases the level of glucose-dependent insulin secretion through cyclic adenosine monophosphate-dependent protein kinase stimulation in the pancreas [82,83,84].…”

A Pragmatic Study of Basal and Mid-Mixture Insulins as Starter Insulins in Chinese Patients With Type 2 Diabetes: Observations From Long-Term, Real-World Experience

“…Premixed insulins contain rapid-and intermediate-acting insulin that control fasting plasma glucose (FPG) and postprandial glucose (PPG) elevations, respectively [9]. In many Asian countries, premixed insulins are more widely used as a starter regimen than basal insulin analog (BI) [9,10].…”