Do premixed insulins have a place in 21st century diabetes care?
Premixed insulins have been around almost from the earliest decades of insulin manufacture. But as innovation in insulin design gathers pace, do they still have a role to play?
Professor Shashank Joshi is in no doubt as to the future of premixed insulin formulations: “Premixed insulins are here to stay,” he says. “Particularly in regions of the world with limited resources and high-carbohydrate diets.”
“We know that a typical Asian with type 2 diabetes eats three times a day. More than 50% of the day is spent in the post-prandial phase and obviously, therefore, it is not just addressing the fasting blood glucose but also the prandial blood glucose which is very crucial and important. Clearly, we know that in Indians the prandial glucose control is higher and has this critical role in HbA1c control. And when you look at a pooled analysis of all the trials, we know that in the Asian population the prandial component matters. We know that a typical basal insulin will control the fasting glucose, control the HbA1c. But it will not control the prandial glucose excursions. To control those, we need premixed insulins.”
Encompassing a broad sweep of topics, from the history of premixed insulins, to international cuisines, to the profiles of action of the latest formulations currently on the market, Professor Joshi’s presentation is a timely reminder of the particular advantages of simplicity and flexibility which premixed formulations can offer, focusing especially on the benefits they present for specific population groups in certain regions of the world. He even suggests that these formulations might help us to tackle that perennial bugbear of insulin initiation and intensification: therapeutic inertia.
About the author
Professor Shashank R Joshi (MD, DM, FACP, FACE, FRCP) is an endocrinologist at the Lilavarti Hospital in Mumbai, India. He is also Chair of the International Diabetes Federation (IDF) South East Asia Chapter, President of the Indian Academy of Diabetes and President of the Association of Physicians of India. He is a former president of the Endocrine Society of India, the Research Society for the Study of Diabetes in India and the All-India Association for Advancement of Research in Obesity. He is Emeritus Editor of the Journal of the Association of Physicians of India (JAPI).