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Use of 50/50 premixed insulin analogs in Type 2 Diabetes: systematic review and clinical recommendations

Deed, Gary, Kilov, Gary, Dunning, Trisha, Cutfield, Richard, Overland, Jane and Wu, Ted 2017, Use of 50/50 premixed insulin analogs in Type 2 Diabetes: systematic review and clinical recommendations, Diabetes therapy, vol. 8, no. 6, pp. 1265-1296, doi: 10.1007/s13300-017-0328-6.

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Title Use of 50/50 premixed insulin analogs in Type 2 Diabetes: systematic review and clinical recommendations
Author(s) Deed, Gary
Kilov, Gary
Dunning, TrishaORCID iD for Dunning, Trisha orcid.org/0000-0002-0284-1706
Cutfield, Richard
Overland, Jane
Wu, Ted
Journal name Diabetes therapy
Volume number 8
Issue number 6
Start page 1265
End page 1296
Total pages 32
Publisher Springer
Place of publication New York, N.Y.
Publication date 2017-12
ISSN 1869-6953
Keyword(s) Biphasic insulin
Diabetes mellitus
Insulin aspart
Insulin lispro
Practice guideline
Systematic review
Type 2
Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
LISPRO MIX 50
ORAL ANTIHYPERGLYCEMIC DRUGS
POSTPRANDIAL BLOOD-GLUCOSE
BASAL-BOLUS THERAPY
THRICE-DAILY LISPRO
OPEN-LABEL
RANDOMIZED-TRIAL
DAILY INJECTIONS
AMERICAN ASSOCIATION
GLYCEMIC VARIABILITY
Summary 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.
Language eng
DOI 10.1007/s13300-017-0328-6
Field of Research 111099 Nursing not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30105708

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.