Premix insulins in type 1 diabetes: the coming of degludec/aspart

ABSTRACT

Introduction: Although premixed fixed ratio NPH insulin products are commonly used in type 2 diabetes patients, the advent of Glargine insulin which cannot be formulated together with a rapid-acting insulin (basal-bolus) has largely eliminated premixed insulin from use in type 1 diabetes. Degludec insulin can be formulated together with Aspart insulin in a 70/30 fixed ratio product. We review the potential use of Degludec-Aspart in type 1 diabetes.

Areas covered: A historical search of the development and use of premixed insulin preparations was performed relying on Pubmed, FDA, and European Union records.

Expert opinion: Degludec is a once daily insulin. There appears to be little advantage to administration of Degludec-Aspart twice daily, and basal bolus injections have proved superior to premixed insulin in type 1 diabetes. There may still be a role for this premixed fixed ratio formulation in patients who have opted to use Technosphere inhaled insulin prior to and post meals. In such patients, the use of a single injection of Degludec-Aspart prior to the largest meal of the day might provide an anchor to allow patients to then self-administer multiple inhalations around mealtimes.

KEYWORDS:

• Insulin Degludec
• insulin Glargine
• hypoglycemia
• Degludec-Aspart

Article highlights

• Premix insulin is used frequently in type 2 diabetes.

• In type 1 diabetes, basal bolus insulin is superior to premixed insulin injections .

• Degludec insulin can be mixed with aspart insulin and a premixed 70/30 formulation is now marketed.

• Degludec-aspart may be given prior to the main meal in type 1 diabetes patients and may spare an additional injection .

• Degludec aspart prior to the main meal may be useful in type 1 diabetes patients taking inhaled insulin .

Declaration of interest

M Rendell has been involved in grant funded studies of insulin Degludec and Glargine. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

One peer reviewer is in the speaker bureau of Bioton, Boehringer-Ingelheim, Eli-Lilly, Novo-Nordisk, MSD, Polfa, Sanofi, and advisory boards for Boehringer-Ingelheim, Novo-Nordisk, MSD. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper has been funded by the Rose Salter Medical Research Foundation and the Association of Diabetes Investigators.