Intensifying existing premix therapy (BIAsp 30) with BIAsp 50 and BIAsp 70: A consensus statement

Abstract

In 2009, consensus guidelines were published on intensification of insulin therapy using the premix analog biphasic insulin aspart (BIAsp) 30 in the treatment of type 2 diabetes, based on the recommendations of an international, independent expert panel. The guidelines included recommendations and titration algorithms for intensification from basal insulin once (OD) or twice daily (BID) to BIAsp 30 BID, from OD BIAsp 30 to BID, and from BID BIAsp 30 to three times daily (TID). Building on these recommendations, the objective was to develop similar, simple and effective guidelines for intensification switch from a BIAsp 30 to a mid-/high-ratio premix regimen for the vast majority of patients with type 2 diabetes. A panel of independent experts with extensive clinical experience in premix analog therapy met in October 2009 to review the therapeutic role of mid- and high-ratio premixes (BIAsp 50 and 70, respectively). The panel outlined a series of algorithms for intensifying BIAsp 30 BID and TID with mid-/high-ratio premixes, along with practical suggestions relating to intensification for individual patients. A simple tool to aid dose adjustment was also developed. The guidelines suggested here should assist physicians in introducing mid-/high-ratio premixes to optimize the insulin therapy of patients with type 2 diabetes who are failing to achieve glycemic targets on a BIAsp 30 BID or TID regimen.

Switching to biphasic insulin aspart 30/50/70 from biphasic human insulin 30/50 in patients with type 2 diabetes in normal clinical practice: observational study results

“…Our findings are consistent with previous reports that BIAsp therapy can be intensified safely 4,20 . Both RCTs and observational studies have shown that improved glycemic control can be achieved without increasing hypoglycemia by increasing the frequency of daily dosing with BIAsp 30 29,30 or by switching to BIAsp 50 three-times daily 31 .…”

Use of 50/50 Premixed Insulin Analogs in Type 2 Diabetes: Systematic Review and Clinical Recommendations

“…Of the 35 studies, there were two systematic reviews or meta-analyses [ 12 , 13 ], 19 RCTs [ 14 – 32 ] (including three crossover studies [ 19 , 25 , 28 ]), two post hoc analyses of pooled data from RCTs [ 33 , 34 ], ten prospective, nonrandomized, observational or interventional studies [ 35 – 44 ], one retrospective observational study [ 45 ], and one consensus statement [ 9 ] (Table S1 in the ESM). Sample sizes ranged from 13 [ 42 ] to 744 [ 23 ]; overall, the studies enrolled more than 6000 patients.…”

“…Several groups have published clinical guidance on the use of low-mix insulin analogs [ 7 , 8 ]. However, to our knowledge, only one group has made clinical recommendations on the use of mid-mix (or high-mix) premixed analogs [ 9 ]. These recommendations, published in 2011 as part of a consensus statement, rely on clinical evidence from just four studies [ 9 ].…”

“…However, to our knowledge, only one group has made clinical recommendations on the use of mid-mix (or high-mix) premixed analogs [ 9 ]. These recommendations, published in 2011 as part of a consensus statement, rely on clinical evidence from just four studies [ 9 ]. Thus, recent evidence-based guidance on the use of Mix50 is lacking.…”

Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes

“…Different ratio premixes, such as 50% soluble rapid-acting insulin/50% protaminated insulin, are also available and can be useful for patients with specific needs (e.g., patients with very high PPG values or problems with hypoglycemia). For information on intensifying to higher ratio premix insulin analogs, refer to the published guidance [ 43 ].…”