title: Clinical use of the co-formulation of insulin degludec and insulin aspart.
abstract: OBJECTIVE
  To provide a review of the available data and practical use of insulin degludec with insulin aspart (IDegAsp). Premixed insulins provide basal and prandial glucose control; however, they have an intermediate-acting prandial insulin component and do not provide as effective basal coverage as true long-acting insulins, owing to the physicochemical incompatibility of their individual components, coupled with the inflexibility of adjustment. The molecular structure of the co-formulation of IDegAsp, a novel insulin preparation, allows these two molecules to coexist without affecting their individual pharmacodynamic profiles.
  
  
  METHODS
  Clinical evidence in phase 2/3 trials of IDegAsp efficacy and safety in type 1 and type 2 diabetes mellitus (T1DM and T2DM) have been assessed and summarised.
  
  
  RESULTS
  In people with T2DM, once- and twice-daily dosing provides similar overall glycaemic control (HbA1c ) to current modern insulins, but with lower risk of nocturnal hypoglycaemia. In prior insulin users, glycaemic control was achieved with lower or equal insulin doses vs. other basal+meal-time or premix insulin regimens. In insulin-naïve patients with T2DM, IDegAsp can be started once or twice-daily, based on individual need. People switching from more than once-daily basal or premix insulin therapy can be converted unit-to-unit to once-daily IDegAsp, although this strategy should be assessed by the physician on an individual basis.
  
  
  CONCLUSIONS
  IDegAsp offers physicians and people with T2DM a simpler insulin regimen than other available basal-bolus or premix-based insulin regimens, with stable daytime basal coverage, a lower rate of hypoglycaemia and some flexibility in injection timing compared with premix insulins.
authors.affiliation: Diabetes Care & Research Centre, Patna, India.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Awata
authors.affiliation: Diabetes Research Unit Cymru, Swansea University & ABM University Health Board, Swansea, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Bain
authors.affiliation: Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.|IRCCS MultiMedica, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ceriello
authors.affiliation: University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: G R
authors.initials: GR
authors.lastname: Fulcher
authors.affiliation: Chellaram Diabetes Institute, Pune, Maharashtra.
authors.forename: A G
authors.initials: AG
authors.lastname: Unnikrishnan
authors.affiliation: Departamento de Endocrinologia, Universidad Autónoma de Guadalajara, Zapopan, Mexico.
authors.forename: R
authors.initials: R
authors.lastname: Arechavaleta
authors.affiliation: Instituto Jalisciense de Investigación en Diabetes y Obesidad S.C. Guadalajara, Jalisco, México.
authors.forename: G
authors.initials: G
authors.lastname: Gonzalez-Gálvez
authors.affiliation: Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Newcastle University, Newcastle upon Tyne, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Home
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kaku
authors.affiliation: Endocrine, Metabolism and Nuclear Medicine Service, Diabetes Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Litwak
authors.affiliation: Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Madsbad
authors.affiliation: Department of Endocrinology, University of Strasbourg, Strasbourg, France.
authors.forename: M
authors.initials: M
authors.lastname: Pinget
authors.affiliation: Department of Endocrinology, National Institute of Medical Sciences and Nutrition, Salvador Zubirán, México City, Mexico.
authors.forename: R
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Division of Endocrinology and Diabetes, Medanta the Medicity, Gurgaon, Haryana, India.
authors.forename: A
authors.initials: A
authors.lastname: Mithal
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Tambascia
authors.affiliation: Queens Diabetes and Endocrinology Associates, Fresh Meadows, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tibaldi
authors.affiliation: Department of Clinical Medicine - The Department of Endocrinology and Diabetes, Aarhus University Hospital, NBG, Aarhus C, Denmark.
authors.forename: J S
authors.initials: JS
authors.lastname: Christiansen
mesh_terms: D001786:Blood Glucose; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D057915:Drug Substitution; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D061267:Insulin Aspart / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; C571886:insulin degludec; D061267:Insulin Aspart