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

INTRODUCTION: Premix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and sw...

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Autores principales: Wu, Ted, Betty, Bryan, Downie, Michelle, Khanolkar, Manish, Kilov, Gary, Orr-Walker, Brandon, Senator, Gordon, Fulcher, Greg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575300/
https://www.ncbi.nlm.nih.gov/pubmed/26104878
http://dx.doi.org/10.1007/s13300-015-0116-0
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author Wu, Ted
Betty, Bryan
Downie, Michelle
Khanolkar, Manish
Kilov, Gary
Orr-Walker, Brandon
Senator, Gordon
Fulcher, Greg
author_facet Wu, Ted
Betty, Bryan
Downie, Michelle
Khanolkar, Manish
Kilov, Gary
Orr-Walker, Brandon
Senator, Gordon
Fulcher, Greg
author_sort Wu, Ted
collection PubMed
description INTRODUCTION: Premix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and switching from basal–bolus to a premix insulin analog when appropriate. METHODS: An independent expert panel formulated recommendations on the use in T2D of the premix insulin analog formulations widely available in Australasia, based on the available evidence and their own experience. RESULTS: Results from trials in both initiation and intensification of insulin show that no single insulin or regimen is best on all endpoints, and that improved glycemic control can be expected regardless of which regimen is used. Thus, individual patient factors and preferences become more important. Guidance is presented to help the clinician choose between a premix insulin analog or basal analog for insulin initiation, and to intensify insulin therapy using premix insulin analogs. Recommendations are made on dosing, titration, the concomitant use of non-insulin glucose-lowering drugs, and other practical issues, and on the special case of switching from basal–bolus to premix insulin analog therapy. CONCLUSION: This guidance is intended to help both general and specialist practitioners make informed choices and provide optimal care for patients with T2D. It emphasizes the importance of taking into account individual patient factors and preferences so that the choice of insulin regimen is individualized to the patient in the same way that glycemic targets are now individualized. FUNDING: Novo Nordisk Region IO A/S. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13300-015-0116-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-45753002015-09-23 Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes Wu, Ted Betty, Bryan Downie, Michelle Khanolkar, Manish Kilov, Gary Orr-Walker, Brandon Senator, Gordon Fulcher, Greg Diabetes Ther Original Research INTRODUCTION: Premix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and switching from basal–bolus to a premix insulin analog when appropriate. METHODS: An independent expert panel formulated recommendations on the use in T2D of the premix insulin analog formulations widely available in Australasia, based on the available evidence and their own experience. RESULTS: Results from trials in both initiation and intensification of insulin show that no single insulin or regimen is best on all endpoints, and that improved glycemic control can be expected regardless of which regimen is used. Thus, individual patient factors and preferences become more important. Guidance is presented to help the clinician choose between a premix insulin analog or basal analog for insulin initiation, and to intensify insulin therapy using premix insulin analogs. Recommendations are made on dosing, titration, the concomitant use of non-insulin glucose-lowering drugs, and other practical issues, and on the special case of switching from basal–bolus to premix insulin analog therapy. CONCLUSION: This guidance is intended to help both general and specialist practitioners make informed choices and provide optimal care for patients with T2D. It emphasizes the importance of taking into account individual patient factors and preferences so that the choice of insulin regimen is individualized to the patient in the same way that glycemic targets are now individualized. FUNDING: Novo Nordisk Region IO A/S. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13300-015-0116-0) contains supplementary material, which is available to authorized users. Springer Healthcare 2015-06-24 2015-09 /pmc/articles/PMC4575300/ /pubmed/26104878 http://dx.doi.org/10.1007/s13300-015-0116-0 Text en © The Author(s) 2015 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original Research
Wu, Ted
Betty, Bryan
Downie, Michelle
Khanolkar, Manish
Kilov, Gary
Orr-Walker, Brandon
Senator, Gordon
Fulcher, Greg
Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes
title Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes
title_full Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes
title_fullStr Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes
title_full_unstemmed Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes
title_short Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes
title_sort practical guidance on the use of premix insulin analogs in initiating, intensifying, or switching insulin regimens in type 2 diabetes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575300/
https://www.ncbi.nlm.nih.gov/pubmed/26104878
http://dx.doi.org/10.1007/s13300-015-0116-0
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