Use of Insulin Degludec/Insulin Aspart in the Management of Diabetes Mellitus: Expert Panel Recommendations on Appropriate Practice Patterns

Abstract

Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (IDeg), which provides long-lasting basal insulin coverage, and insulin aspart (IAsp), which targets post-prandial glucose. This expert panel aimed to provide a practical and implementable guidance document to assist clinicians in prescribing IDegAsp in the diabetes management with respect to different patient populations including children and adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) as well as pregnant, elderly and hospitalized patients and varying practice patterns (insulin-naive, insulin-treated, switching from basal, basal bolus and premix regimens). The experts recommended that IDegAsp can be used in insulin-naive T2D patients with poor glycemic control (HbA1c >8.5%) despite optimal oral antidiabetic drugs (OADs) as well as in insulin-treated T2D patients by switching from basal insulin, basal-bolus therapy or premixed insulins in relation to lower risk of nocturnal hypoglycemia, fewer injections and lower intraday glycemic variability, respectively. The experts considered the use of IDegAsp in children with T2D as a basal bolus alternative rather than as an alternative to basal insulin after metformin failure, use of IDegAsp in adult T1D patients as a simplified basal bolus regimen with lesser nocturnal hypoglycemia, fewer injections and better fasting plasma glucose control and in children with T1D as an alternative insulin regimen with fewer injection to increase treatment adherence. The proposed expert opinion provides practical information on use of IDegAsp in different patient populations and practice patterns to assist clinicians, which seems to compensate the need for easily implementable guidance on this novel insulin regimen.

Intensification of Insulin Treatment With Insulin Degludec/Aspart in Type 2 Diabetic Patients: A 2-Year Real-World Experience

“…Shifting to IDegAsp treatment for two years maintained glycemic control, increased total daily insulin but stable IDegAsp insulin dose requirements in comparison with the baseline data. IDegAsp treatment also reduced FPG an HbA1c values, which were consistent with the individual trials ( 14 , 15 ).…”

Comparative Analysis of Clinical Effects of Insulin Aspart Combined with Acarbose and Metformin in the Treatment of Diabetes Mellitus

“…If the insulin dose was not up to the standard before dinner, Novoray 30 was added before lunch to adjust to the standard before dinner. Blood sugar control target: fingertip blood sugar was 4.2-7.0 mmol/L before three meals and before going to bed [10].…”

Medical Experts’ Agreement on Risk Assessment Based on All Possible Combinations of the COVID-19 Predictors—A Novel Approach for Public Health Screening and Surveillance

“…Existing methods to determine experts’ judgement on combinations of criteria include the use of a panel of experts [ 28 ], an open forum of discussions with consensus statements [ 29 ], and a systematic approach to reaching consensus such as the Delphi method [ 30 ]. In comparison, the novel method adopted in this study offered a practical alternative to survey independent individual experts’ judgement.…”