Number-Based Approach to Insulin Taxonomy

Abstract

This article describes a number-based system for the classification of insulin regimes. It utilizes a patient-centered variable (number of injections per day) and pharmacokinetic/dynamic characteristics to craft a taxonomic system that is able to incorporate all available insulin preparations and coformulations. This framework of systematics is robust enough to include various molecules that have been recently developed. It serves to enhance understanding of the subject, and facilitates the practical or clinical usage of theoretical knowledge. We propose that number-based insulin taxonomic models should be used in clinical guidelines and recommendations rather than restricting ourselves to pharmaceutical-based classifications. PubMed articles including both review articles and clinical trials published since the year 1990 were searched, to gather evidence and information on the various types of insulins available, and how they can be used, based on the number or frequency of injections prescribed per day.

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

“…A number-based insulin taxonomic model has been developed to offer a more patient-centric care for diabetes [ 41 ]. This model, based on variables such as the number of injections per day and the pharmacokinetic and pharmacodynamic characteristics of insulin preparations, helps inform the choice of therapy with available formulations of insulin.…”

“…Premixed insulin formulations can be combined with bolus insulins to customize the insulin regimens to suit individual glycemic profiles and patient needs in diabetics [ 41 ]. In patients with severe insulin deficiency or resistance, IDegAsp may be administered with the main meal and IAsp may be administered with the other two meals to build a three-dose intensive regimen for achieving glycemic targets [ 23 ].…”

Flexibility in insulin prescription

“…Recently, a number-based taxonomy approach has been used to provide a framework which can include both traditional as well as newly developed insulin regimes. [ 4 ]…”

“…[ 9 ] The injections have to be taken with the same meal (s) every day, whether in a once daily, twice daily or thrice daily dose. [ 4 ] Insulin co-formulations such as I Deg Asp (insulin degludec aspart) offer the flexibility of change in timing of administration. For example, a person on a once daily regime of I Deg Asp, to be taken with the major meal, may choose to have his injection at breakfast on one day, and at lunch or dinner on the next.…”