title: Practical Guidance on the Use of Premix Insulin Analogs in Initiating, Intensifying, or Switching Insulin Regimens in Type 2 Diabetes.
abstract: BACKGROUND
  Premix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and switching from basal-bolus to a premix insulin analog when appropriate.
  
  
  METHODS
  An independent expert panel formulated recommendations on the use in T2D of the premix insulin analog formulations widely available in Australasia, based on the available evidence and their own experience.
  
  
  RESULTS
  Results from trials in both initiation and intensification of insulin show that no single insulin or regimen is best on all endpoints, and that improved glycemic control can be expected regardless of which regimen is used. Thus, individual patient factors and preferences become more important. Guidance is presented to help the clinician choose between a premix insulin analog or basal analog for insulin initiation, and to intensify insulin therapy using premix insulin analogs. Recommendations are made on dosing, titration, the concomitant use of non-insulin glucose-lowering drugs, and other practical issues, and on the special case of switching from basal-bolus to premix insulin analog therapy.
  
  
  CONCLUSIONS
  This guidance is intended to help both general and specialist practitioners make informed choices and provide optimal care for patients with T2D. It emphasizes the importance of taking into account individual patient factors and preferences so that the choice of insulin regimen is individualized to the patient in the same way that glycemic targets are now individualized.
  
  
  BACKGROUND
  Novo Nordisk Region IO A/S.
authors.affiliation: Royal Prince Alfred Hospital, Camperdown, NSW, Australia. ted.wu@sswahs.nsw.gov.au.
authors.forename: Ted
authors.initials: T
authors.lastname: Wu
authors.affiliation: Porirua Union and Community Health Service, Cannons Creek, Porirua City, New Zealand.
authors.forename: Bryan
authors.initials: B
authors.lastname: Betty
authors.affiliation: Southland Hospital, Invercargill, New Zealand.
authors.forename: Michelle
authors.initials: M
authors.lastname: Downie
authors.affiliation: Auckland District Health Board Diabetes Centre, Greenlane Clinical Centre, Auckland, New Zealand.
authors.forename: Manish
authors.initials: M
authors.lastname: Khanolkar
authors.affiliation: The Seaport Practice, Launceston, TAS, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Kilov
authors.affiliation: Counties Manukau District Health Board, Manukau, New Zealand.
authors.forename: Brandon
authors.initials: B
authors.lastname: Orr-Walker
authors.affiliation: Specialist Medical Services, Southport, QLD, Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Senator
authors.affiliation: University of Sydney, Sydney, NSW, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Fulcher
keywords: Basal insulin; Biphasic insulin aspart; Biphasic insulin lispro; Insulin initiation; Insulin intensification; Premix insulin analogs