The use of U‐500 regular insulin in the management of patients with obesity and insulin resistance

Jones, Peter P.; Idris, Iskandar

doi:10.1111/dom.12094

Cited by 23 publications

(28 citation statements)

References 36 publications

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“…Prior to the U-500R titration-to-target trial, 1 clinicians had only their own clinical experience and largely retrospective, nonrandomized case reports/series, 25-29 real-world evidence studies, 30-32 and clinical reviews 3-5,33-37 to inform U-500R use. Treatment approaches varied among clinicians and experts, with some initiating U-500R with 1-to-1 total daily dose (TDD) transition (U-100 insulins to U-500R) evenly split over multiple daily doses (BID, TID, or 4-times-daily [QID]).…”

Section: Prior U-500r Dosing Recommendationsmentioning

confidence: 99%

Translating U-500R Randomized Clinical Trial Evidence to the Practice Setting: A Diabetes Educator/Expert Prescriber Team Approach

et al. 2017

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PurposeThe purpose of this article is to provide recommendations to the diabetes educator/expert prescriber team for the use of human regular U-500 insulin (U-500R) in patients with severely insulin-resistant type 2 diabetes, including its initiation and titration, by utilizing dosing charts and teaching materials translated from a recent U-500R clinical trial.ConclusionsClinically relevant recommendations and teaching materials for the optimal use and management of U-500R in clinical practice are provided based on the efficacy and safety results of and lessons learned from the U-500R clinical trial by Hood et al, current standards of practice, and the authors’ clinical expertise. This trial was the first robustly powered, randomized, titration-to-target trial to compare twice-daily and three-times-daily U-500R dosing regimens. Modifications were made to the initiation and titration dosing algorithms used in this trial to simplify dosing strategies for the clinical setting and align with current glycemic targets recommended by the American Diabetes Association. Leveraging the expertise, resources, and patient interactions of the diabetes educator who can provide diabetes self-management education and support in collaboration with the multidisciplinary diabetes team is strongly recommended to ensure patients treated with U-500R receive the timely and comprehensive care required to safely and effectively use this highly concentrated insulin.

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Section: Prior U-500r Dosing Recommendationsmentioning

confidence: 99%

Translating U-500R Randomized Clinical Trial Evidence to the Practice Setting: A Diabetes Educator/Expert Prescriber Team Approach

et al. 2017

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“…31,32 Efficacy studies of U-500R have already been published. 33,34 In a retrospective database analysis, U-500R was found to be more economical in pharmacy and overall cost and compliance but with a slightly higher rate of hypoglycaemia compared with U-100R. 35 Variability in absorption from day to day and from different parts of the body appears to be less.…”

Section: U-500rmentioning

confidence: 99%

Insulin U100, 200, 300 or 500?

Dashora

Castro

2016

Br J Diabetes

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This article reviews the currently available information about insulin preparations in a concentration higher than 100 units/mL. These might be particularly useful in people with significant insulin resistance and high insulin requirement. U-200 insulin has low variability and lower (nocturnal) or similar risk of hypoglycaemia compared with U-100 insulin but is currently more expensive. U-300 glargine insulin has low variability, less weight gain and lower nocturnal hypoglycaemia in some studies in comparison to U-100 glargine. It is priced lower than U-100 glargine. U-500R insulin has been in use for some time worldwide but is not licensed in the UK. It also has low variability and lower cost per unit of insulin compared with U-100R. There is no specific delivery device and it has a higher risk of hypoglycaemia and weight gain. More insulins are in development (U-500 short-acting analogue [Fluorolog] and U-400 pre-mix like insulin BIOD-531, amongst others). Br J Diabetes 2016;16:10-15

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“…Particularly during care transitions and/or in hospital settings, patients using concentrated U-500 insulin were at increased risk for medication errors. 6,7 Reports of insulin administration errors related to the use of U-500 insulin in hospital settings are well documented. [5][6][7][8] Errors have multiple contributing factors.…”

Section: New Insulin Preparations: Potential Benefits and Risk Assessmentioning

confidence: 99%

New Insulin Preparations: Potential Benefits and Risk Assessments

Brackney¹

2016

The Journal for Nurse Practitioners

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Concentrated insulins have been especially problematic high alert medications. On February 25, 2015 Federal Drug Administration (FDA) approval made available insulin glargine, Toujeo U-300 (300 units/ml) in a SoloSTAR pen. On May 27, 2015 the FDA approved insulin lispro, Humalog U-200 (200 units/ml) KwikPen. Increased incidence of insulin resistant type 2 diabetes has escalated the need for concentrated insulin. This paper discusses each insulin, appropriate patient selection, benefits of the new insulins for people with diabetes and providers, and suggestions for prevention of potential off-label use of insulin pens. Counseling and assessment are essential to avoid unintended harm.

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The use of U‐500 regular insulin in the management of patients with obesity and insulin resistance

Cited by 23 publications

References 36 publications

Translating U-500R Randomized Clinical Trial Evidence to the Practice Setting: A Diabetes Educator/Expert Prescriber Team Approach

Translating U-500R Randomized Clinical Trial Evidence to the Practice Setting: A Diabetes Educator/Expert Prescriber Team Approach

Insulin U100, 200, 300 or 500?

New Insulin Preparations: Potential Benefits and Risk Assessments

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