Are new combinations of insulin safe and more effective?

This study investigated the safety and effectiveness of a combination of two different types of insulin (IDegAsp) in people with type 2 diabetes (T2D). It was determined that IDegAsp was safe and effective at controlling blood glucose levels in a variety of patients.

People with T2D can control their symptoms, at first, with lifestyle changes (such as a healthy diet and exercise) and non-insulin medications. However, many people will eventually need insulin to maintain control.

Most people with T2D begin with one injection of a long-acting form of insulin, such as insulin degludec (IDeg), once a day (basal dose). However, because blood glucose levels can rise rapidly after a meal, injections of short-acting insulin, such as insulin aspart (IAsp), are often added at mealtimes (bolus dose). This is called basal-bolus dosing.

Some patients may use ‘premixed’ insulin. This is where long-acting and short-acting insulins are given at the same time, in the same injection. Biphasic insulin aspart (BIAsp), where two types of insulin aspart are used, is one type. IDegAsp is a new combination that uses IDeg and IAsp in one injection. Previous research suggests that IDegAsp controls blood glucose levels more effectively than other insulins, and also reduces side effects. It is not clear whether those results will apply to people with T2D who have different levels of glycemic control, different body weights, and different durations of diabetes.

This study compared the results of 5 different studies. 1808 adults with T2D participated. They were divided into 3 groups. 1111 received IDegAsp. 561 received BIAsp. 136 received basal-bolus therapy with IDeg and IAsp. They were followed up for 26 weeks.

HbA1c (average blood glucose over the last 3 months) at the end of the study was similar in all groups. HbA1c was not affected by glycemic control at the start of the study, body weight, or duration of diabetes.

Fasting blood glucose (FBG; blood glucose after a period without food or drink) was lower with IDegAsp than in other groups at the end of the study. Those who had low FBG at the start of the study did not change significantly. Otherwise, FBG was not affected by glycemic control, weight, and duration of diabetes.

The IDegAsp group required lower insulin doses at the end of the study compared to other groups. People treated with IDegAsp who had HbA1c levels between 7.5-8% at the start of the study, who had diabetes for more than 10 years, and who were not obese, had significantly lower insulin doses at the end of the study than people in other groups.

The IDegAsp group had lower rates of hypoglycemia (dangerously low blood glucose) than other groups. 

The study concluded that IDegAsp is as effective as other types of insulin in controlling blood glucose, reduces the amount of insulin needed, and reduces the risk of hypoglycemia. This was seen in various different types of people with T2D.

Differences between the different studies may have affected the results. For example, the participants in different studies received different treatments in addition to insulin. The study did not examine the long-term effects of IDegAsp. Furthermore, the study was funded by Novo Nordisk, the manufacturers of IDegAsp.

Discuss the advantages and disadvantages of different types of insulin with your physician.