Clinical Experience with Biphasic Insulin Aspart 30 (NovoMix® 30)
This editorial introduces four case studies examining the initiation of biphasic insulin aspart 30 (BIAsp 30), including one case in insulin initiation, two cases of switching from biphasic human insulin (BHI) and one case of intensifying basal insulin treatment.
Biphasic human insulin 30 (BHI 30), biphasic insulin aspart 30 (BIAsp 30), fasting plasma glucose (FPG), HbA1c, insulin, insulin glargine, postprandial glucose (PPG), type 2 diabetes
Disclosure: Robert Ligthelm has received honoraria from the pharmaceutical industry, including Novo Nordisk, and has been a member of Novo Nordisk advisory boards.
Acknowledgements: Medical writing support was provided by Watermeadow Medical Ltd, funded by Novo Nordisk.
Received: 2 September 2011 Accepted: 8 September 2011 Citation: European Endocrinology, 2011;7(2):119–20
Correspondence: Robert Ligthelm, EHM Clinic, Hoofddorp’s Gravenweg 53, 3062 ZB Rotterdam, The Netherlands. E: firstname.lastname@example.org
Support: The publication of this article was funded by Novo Nordisk A/S, Denmark. The views and opinions expressed are those of the author and not necessarily those of Novo Nordisk A/S, Denmark.
Biphasic insulin aspart 30 (BIAsp 30) is a premix insulin analogue containing 30 % rapid-acting insulin aspart (IAsp) and 70 % protamineretarded IAsp. With mealtime administration, the rapid-acting IAsp component provides coverage for postprandial glucose (PPG) while the protaminated component provides intermediate coverage for basal glycaemic control. Therefore, premix insulin analogues, such as BIAsp 30, offer a convenient way for patients to control fasting glucose and PPG without the need for two insulins. Due to this simplicity, premix insulins can assist patients through the often difficult step of insulin initiation; and by adding extra doses with meals (up to three times daily), they also provide a straightforward route to insulin intensification.
Insulin initiation is an important and necessary step for many patients with type 2 diabetes, but there are a number of barriers that can delay patients and their physicians in taking this action. Every patient will have individual concerns, so it is important for the healthcare provider to identify and respond to these on a case-by-case basis. However, common barriers include worries about incorporating somewhat inflexible and complex insulin dosing regimens into daily life, worries about public injection or fear of hypoglycaemia.1,2 There may also be reluctance on the part of the healthcare provider, who may feel that insulin initiation is a time-consuming and complex process and may lack the time or resources to provide adequate education and training.1,2 Diabetes self-management education is an important part of the insulin initiation process.1,3 Patients who understand the need for insulin initiation, and who know what options are available and which ones might be most appropriate for them, are more likely to accept insulin initiation. Similarly, practical guidance on self-managing their diabetes with insulin provides patients with the confidence to make this major change in their diabetes therapy.
Another important factor in insulin initiation is providing patients with simple insulin regimens that they can incorporate easily into their everyday life. Therefore, many patients will initiate a once-daily insulin, such as a premix insulin taken with their main meal or existing basal insulin. In choosing appropriate options, factors including lifestyle, current glycaemic control and preference for injection device will need to be considered. As their diabetes progresses, individuals may need to intensify treatment beyond once-daily dosing. With premix insulins, it is straightforward to add extra doses with meals.4 Studies have shown that twice-daily and three-times-daily BIAsp 30 are efficacious and safe.5–7 For basal insulins, intensification is more complex. Patients may need to add a second rapid-acting insulin to one or more meals or switch to a premix insulin, both of which require patients to familiarise themselves with a new insulin.