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2017 ; 8
(6
): 1265-1296
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gab.com Text
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English Wikipedia
Use of 50/50 Premixed Insulin Analogs in Type 2 Diabetes: Systematic Review and
Clinical Recommendations
#MMPMID29116584
Deed G
; Kilov G
; Dunning T
; Cutfield R
; Overland J
; Wu T
Diabetes Ther
2017[Dec]; 8
(6
): 1265-1296
PMID29116584
show ga
INTRODUCTION: Premixed insulin analogs represent an alternative to basal or
basal-bolus insulin regimens for the treatment of type 2 diabetes (T2D).
"Low-mix" formulations with a low rapid-acting to long-acting analog ratio (e.g.,
25/75) are commonly used, but 50/50 formulations (Mix50) may be more appropriate
for some patients. We conducted a systematic literature review to assess the
efficacy and safety of Mix50, compared with low-mix, basal, or basal-bolus
therapy, for insulin initiation and intensification. METHODS: MEDLINE, EMBASE,
Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LillyTrials.com, and
NovoNordisk-trials.com were searched (11 or 13 Dec 2016) using terms for T2D,
premixed insulin analogs, and/or Mix50. Studies (randomized, nonrandomized, or
observational; English only) comparing Mix50 with other insulins (except human)
and reporting key efficacy [glycated hemoglobin (HbA1c), fasting and postprandial
glucose] and/or safety (hypoglycemia, weight gain) outcomes were eligible for
inclusion. Narrative reviews, letters, editorials, and conference abstracts were
excluded. Risk of bias in randomized trials was assessed using the Cochrane tool.
RESULTS: MEDLINE and EMBASE searches identified 716 unique studies, of which 32
met inclusion criteria. An additional three studies were identified in the other
databases. All 19 randomized trials except one were open label; risk of other
biases was generally low. Although not conclusive, the evidence suggests that
Mix50 may provide better glycemic control (HbA1c reduction) and, particularly,
postprandial glucose reduction in certain patients, such as those with high
carbohydrate diets and Asian patients, than low-mix and basal therapy. Based on
this evidence and our experience, we provide clinical guidance on factors to
consider when deciding whether Mix50 is appropriate for individual patients.
CONCLUSIONS: Mix50 may be more suitable than low-mix therapy for certain
patients. Clinicians should consider not only efficacy and safety but also
patient characteristics and preferences when tailoring insulin treatment to
individuals with T2D. FUNDING: Eli Lilly.
free
free
free
