Options for Intensification with Biphasic Insulins in Patients with Type 2 Diabetes Not Achieving Glycemic Control

Background: In type 2 diabetes, simple, convenient and effective regimens should encourage timely insulin initiation and improve outcomes. Longand rapid-acting insulin analogues more closely mimic endogenous basal/prandial insulin secretion than human equivalents. Premixed insulin analogues deliver prandial and basal insulin in one formulation and can be administered 1-3 times daily. Premixed insulin may, therefore, provide an alternative to basal–bolus regimens for intensification of insulin therapy.Objectives: The aim of this commentary was to show how biphasic insulin therapy may offer a simple and effective intensification option for patients with type 2 diabetes who do not achieve adequate control with existing insulin therapies.Methods: A literature search using the PubMed database (years: January 1997September 2010) was carried out using the search terms diabetes AND ([(biphasic OR bi-phasic) AND (insulin OR insulins]) OR ([premix OR pre-mix) AND (insulin OR insulins)]). Clinical trials, systematic reviews, case reports or clinical practice guidelines that addressed topics of interest with regard to premixed insulin analogues/analogue regimens and intensification strategies were identified and included.Results: Clinical data show that premixed insulin analogues reduce hemoglobin A1C and fasting plasma glucose to a similar extent as premixed human insulin, but have advantages in terms of postprandial glucose control, incidence of hypoglycemia, and convenience. Premixed insulins may also provide benefits to glycemic control (reduced HbA1c, fasting and postprandial plasma glucose) in patients failing to achieve targets on basal insulin. In addition, premixed insulin analogue regimens generally compare well with basal–bolus regimens. Conclusions: Premixed insulin analogues offer a simple intensification option in patients with type 2 diabetes not achieving adequate control with existing insulin therapy. Premixed insulin analogues may offer a viable alternative to basal–bolus regimens and an improved physiologic profile compared with human equivalents.