Injectable combination therapies for the management of diabetes: an Indian perspective

ABSTRACT

Introduction: This review focuses on currently available injectable combination therapies (ICTs) for managing diabetes.

Areas covered: References were identified through searches of PubMed, Medline, and Embase for articles published till July 2019 using terms ‘insulin’ [MeSH Terms] OR ‘glucagon like peptide 1 analogue’ [All Fields] OR ‘combination therapy’ [All Fields] ‘combination insulin therapy’ [All Fields] OR ‘combination GLP1 analogue therapy’ [All Fields] OR ‘premixed insulin’ [All Fields].

Expert opinion: Currently, there are nine types of ICTs for diabetes available. ICTs are classified on the basis of whether they are combinations of conventional human insulin, human insulin analogs, insulin coformulations, and insulin glucagon-like peptide-1 receptor agonists (GLP-1RA) and have a subtle difference in pharmacokinetic and pharmacodynamic properties. ICTs have been consistently demonstrated to play a major role in improving glycemic control. In a different meta-analysis involving patients assessed for glycemic control as the primary endpoint, no significant difference was noted with regard to HbA1c reduction, hypoglycemia, weight change, and daily insulin dose in patients on basal-bolus regimen, as compared to ICTs. All international guidelines recommend ICTs for treatment intensification.

ICTs provide more flexibility to the treating doctor in fine-tuning the insulin/GLP-1RA regimen and have the advantages of reducing daily needle-prick count and better long-term compliance.

KEYWORDS:

• Insulin therapy
• premixed insulin
• insulin regimen
• hypoglycemia

Article Highlights

• ICTs are popular in diabetes management because of the reduced daily needle-prick count and ease of use

• Most guidelines recommend ICTs for insulin intensification

• GLP-RA-based ICTs have the advantage of causing weight loss

• ICTs should be used at the lowest possible dose to obtain optimal glycemic effects with minimal hypoglycemia and weight gain.

• NPH insulin-based ICTs need proper resuspension before use to reduce interday and intraday variability in glycemic response

• Increased costs of newer analog insulin-based ICTs and GLP1a-based ICTs are a major hinderance to their long-term use in people living with diabetes in the developing world

This box summarizes the key points contained in the article.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.