Efficacy and safety of premixed insulin analogs in Asian patients with type 2 diabetes: A systematic review

Abstract

Aims/IntroductionThe primary aim of this systematic review was to provide an overview of the efficacy and safety of premixed insulin analogs in Asians, specifically East Asians, with type 2 diabetes.Material and MethodsThe MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov databases were searched from 1 January 1995 to 26 November 2015. Randomized controlled trials involving East Asians with type 2 diabetes treated with any premixed insulin analog were included. Major comparator treatments were basal insulin and basal–bolus insulin. Comparisons were also made between East Asian and Caucasian patients. The primary efficacy outcome was glycated hemoglobin change from baseline to end‐point. The primary safety outcome was the incidence of hypoglycemia.ResultsA total of 21 studies were included; most (n = 14) were carried out in China or Japan. The duration of treatment ranged from 12 to 48 weeks. The glycated hemoglobin mean/least squares mean change from baseline to end‐point after treatment with premixed insulin analogs ranged from −0.12 to −4.2% (improvement was generally more pronounced with insulin initiation vs intensification). The incidence of hypoglycemia ranged from 8.3 to 72.0% in most studies, with the variability reflecting the definition of hypoglycemia used. Efficacy and safety outcomes for premixed insulin analogs were generally similar to those for basal or basal–bolus insulin. Limited evidence suggests that dosing, efficacy and safety profiles might differ slightly between East Asian and Caucasians receiving premixed insulin analogs.ConclusionsThese results support the current use of premixed insulin analogs for managing East Asian patients with type 2 diabetes.

Comparison of the Effect of Glycemic Control in Type 2 Diabetes Outpatients Treated With Premixed and Basal Insulin Monotherapy in China

“…Consistent with our results, the DURABLE study ( 20 , 21 ) showed that a premixed insulin analog had a slightly higher proportion of patients attaining the target HbA1c than basal insulin. However, a systematic review recently reported that the change of HbA1c was not significantly different between the premixed insulin analog and basal groups ( 14 ). Several reasons might be account for the better efficacy of premixed insulin in our study.…”

“…In China, Ji and colleagues showed that after failure of oral hypoglycemic medications, initiating treatment with premixed insulin was able to achieve glycemic control in 70% of T2DM patients ( 13 ). A systematic review study of randomized controlled trials showed that premixed insulin can be a simple and effective means of T2DM treatment in East Asians, and its safety is generally similar to that of basal or basal-bolus insulin ( 14 ). In the hospital setting, premixed insulin was reported to be effective in improving hyperglycemia and controlling HbA1c in T2DM inpatients, and the effect was also similar to inpatients receiving basal insulin ( 15 ).…”

Use of Insulin Glargine 100 U/mL for the Treatment of Type 2 Diabetes Mellitus in East Asians: A Review

“…Use of premixed formulations for initiation of insulin therapy is particularly common in East Asian patients with T2DM as a result of the higher prevalence of postprandial hyperglycemia vs Caucasians with T2DM [ 61 ]. A number of RCTs compared the efficacy and safety of IGlar (with/without prandial insulin) with that of premixed human and analog insulins for initiation [ 62 – 67 ] or intensification [ 68 – 70 ] of insulin therapy in East Asians with T2DM (Table 3 ).…”

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

“…Premixed insulin analogs have efficacy and safety outcomes similar to those of basal or basal-bolus insulin [ 24 , 25 ]. In a review comparing premixed and basal plus regimens, Downie et al reported similar efficacy and safety with both regimens for both insulin initiation in insulin-naïve patients and intensification in patients who have failed on basal insulin [ 26 ].…”