echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Endocrine System > The latest dual insulin analogues are included in the 2020CDS insulin initiation treatment plan as a separate category

    The latest dual insulin analogues are included in the 2020CDS insulin initiation treatment plan as a separate category

    • Last Update: 2021-05-21
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com
    *Only for medical professionals to read and interpret the characteristics of the new insulin initial treatment plan! The world's first soluble di-insulin degluaspart-di-insulin injection was launched in China on December 7, 2019; it will be officially included in the national medical insurance reimbursement scope from March 1, 2021.

    In the 2020 edition of the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" written by the Diabetes Branch of the Chinese Medical Association (CDS), not only the double insulin analogues have been added to the treatment classification of type 2 diabetes, but Degu aspartame is the only one.
    Double insulin has become the first-line choice for insulin initiation therapy.

    The following editor will show you the detailed content recommended by the guide! 01Insulin treatment path map update: add new hypoglycemic plan 2020 version of the guideline insulin path diagram and the previous version of the guideline insulin treatment start time is both, after 3 months of oral hypoglycemic drugs treatment HbA1c ≥ 7.
    0%, consider starting insulin Treatment, but there is a very eye-catching change-double insulin analogues have been added to the initial insulin treatment plan (Figure 1) [1-2].

    Figure 1 After 3 months of oral hypoglycemic treatment, the insulin treatment path for type 2 diabetic patients with HbA1c≥7.
    0% For double insulin analogues, the 2020 version of the guide points out that the only dual insulin analogues currently on the market are degluaspartin.
    The drug generally starts from 0.
    1 to 0.
    2 U/kg−1·d−1 and is injected before the main meal.
    The dose is adjusted according to the fasting blood glucose level until the target is reached.

    Patients with obesity or HbA1c> 8.
    0% may choose to start with a higher dose.

    Degu aspart insulin is treated once a day, and the dose reaches 0.
    5 U·kg-1·d-1 or 30~40 U after a meal and blood glucose is still poorly controlled, or when the patient has two main meals a day, consider changing it Inject twice a day [1].It is said that evidence-based promotes the changes in the guidelines.
    What characteristics and evidence-based evidence of the newly added dual insulin are favored by the guidelines? 02 Biphasic, single peak, stable dual control sugar As the world's first soluble dual insulin preparation, deglubber is a soluble insulin composed of 70% deglubber and 30% insulin aspart.

    Insulin degludec has a half-life of up to 25 hours, and the variability of blood glucose during the day is only 1/4 of that of insulin glargine, which can smoothly cover the management of fasting blood glucose 24 hours a day; insulin aspart has more than 20 years of clinical experience and can quickly Reduces postprandial blood glucose (PPG), and has little variability in the human body [3-4].

    An outstanding feature of the preparation is that the two insulin components can exist independently in the preparation and in the body, without interfering with each other, and effectively control fasting blood glucose and postprandial blood glucose [3].

    With such pharmacodynamic characteristics, the single-injection glucose infusion rate curve is biphasic and single-peak, which can not only take into account fasting and postprandial blood sugar, but also avoid peaks similar to intermediate-acting insulin injections, reducing the "shoulder effect", and more A good simulation of physiological insulin secretion (Figure 2) helps to avoid hypoglycemia [5].

    Figure 2 Degu aspart double insulin can achieve biphasic and single peak, stable sugar control 03 rich evidence-based, both effectiveness and safety The 2020 version of the guidelines quoted the multinational consensus on the clinical application of Degu aspart double insulin, consensus collection Expert opinions from Mexico, Australia, Japan, South Africa, Switzerland and other countries introduced the pharmacokinetic characteristics of Degu aspartic insulin and its rich clinical research results (Figure 3) [6].

    Figure 3 Part of the evidence-based evidence listed in the consensus [6] In the initial insulin therapy, compared with basal insulin, degluaspart insulin is more effective and safer.

    The Phase 3 clinical trial Onishi study included 296 T2DM patients who used oral hypoglycemic agents and had poor blood sugar control (≥1 fixed-dose oral hypoglycemic drugs but poor blood sugar control), and they were randomly given at a ratio of 1:1 Degu aspart double insulin QD/insulin glargine QD treatment [7].

    After 26 weeks of follow-up, it was found that compared with the insulin glargine QD regimen, the degluaspartate QD regimen can significantly reduce the patient’s HbA1c (P<0.
    01), the rate of blood glucose control reaching the standard (HbA1c<7%) is higher, and it is confirmed The number of hypoglycemia and night confirmatory hypoglycemia events was even lower (P=NS).

    In addition, the proportion of patients with HbA1c<7% and no confirmed hypoglycemia in the Degu aspartic double insulin group was higher (43% vs 25%; P<0.
    01) [7].

    In the initial insulin therapy, compared with premixed insulin, degluaspartin di-insulin is more effective and safer.

    In a 26-week open-label, randomized controlled, parallel-armed Start Twice Daily clinical study, for patients with poor blood glucose control of oral hypoglycemic drugs (metformin ± another type of oral hypoglycemic drugs but blood glucose control is not Good), as an insulin initiation program, the Degu aspartic insulin BID was compared with the premixed insulin BID control group.

    The results showed that the HbA1c in the Degu aspart insulin group could be reduced to 6.
    6%, which was equivalent to the reduction in the control group.
    However, the fasting blood glucose of the patients who used the Degu aspart insulin decreased better (-4.
    3mmol/L vs -3.
    3mmol/L) )[8].

    In addition to the initial insulin therapy, for patients who have been using insulin therapy (whether they have previously used basal insulin or premixed insulin), degluaspartin diinsulin also has a wealth of evidence-based evidence [9-12], such as Step The by step study shows that, compared with insulin glargine combined with 1 to 3 injections of insulin aspart, the use of degluaspart insulin has fewer injections, fewer doses, equivalent efficacy, and can significantly reduce the nighttime confirmation Risk of hypoglycemia (P=0.
    018) [9].

    Summary The CDS guidelines are updated approximately every 4 years.
    The important significance of its formulation and update is to provide doctors with appropriate guidance and promote standardized clinical diagnosis and treatment. This time, the updated insulin treatment path of the 2020 version of the guidelines provides the clinic with a new sugar-controlling tool Degu aspart insulin, which has both effectiveness and safety.
    At present, the drug has been included in medical insurance, which will also help improve The accessibility of patients will benefit more patients! References: [1], Diabetes Branch of Chinese Medical Association.
    Chinese Journal of Diabetes, 2021, 13(4):315-408.
    [2], Diabetes Branch of Chinese Medical Association.
    Chinese Journal of Practical Internal Medicine, 2018, 38(04 ):292-344.
    [3], Haahr H, et al.
    Clin Pharmacokinet.
    2017,56(4):339-354.
    [4], Heise, et al.
    Diabetes Obes Metab.
    2012,14:859-64 .
    [5], Atkin S, et al.
    Ther Adv Chronic Dis.
    2015,6(6):375-388.
    [6], Roopa Mehta, et al.
    Diabetes Obes Metab.
    2020,22(11):1961- 1975.
    [7], OnishiY, et al.
    Diabetes Obes Metab.
    2013,15:826–832.
    [8], Franek E, et al.
    Diabet Med.
    2016,33(4):497-505.
    [9] , Philis-Tsimikas A, et al.
    Diabetes Res Clin Pract.
    2019,147:157-165.
    [10], Kaneko S, et al.
    Diabetes Res Clin Pract.
    2015,107:139-147.
    [11], Christiansen JS, et al.
    J Diabetes.
    2016,8:720-728.
    [12], Kumar S, et al.
    Diabet Med.
    2017,34: 180-188.
    For submission/reprint/business cooperation, please contact: pengsanmei@yxj .
    org.
    cn  
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.