Insulin Initiation With Novo Mix 30 Masoud Rahmanian

Insulin Initiation With Novo. Mix 30 Masoud Rahmanian MD

Need for treatment intensification Bergenstal 2001; Wright 2002

Insulin therapy with Novo. Mix® 30 Current diabetes targets and guidelines *

Insulin therapy with Novo. Mix® 30 Hb. A 1 c targets are converging Good glycaemic control ADA/EASD consensus Hb. A 1 c <7% IDF Hb. A 1 c≤ 7. 0% CDA (Canada) Hb. A 1 c ≤ 7% AACE (USA) Hb. A 1 c≤ 6. 5% NICE (UK) Hb. A 1 c 6. 5 -7. 5% Slide No 5 *

Insulin therapy with Novo. Mix® 30 Individualising Hb. A 1 c goals Psycho. Patientcentred care Bio- -social Slide No 6 Inzucchi et al. Diabetes Care 2012; 35: 1364– 79 *

Insulin therapy with Novo. Mix® 30 Yet good glycaemic control is not achieved Hb. A 1 c (%) 10. 0 12. 4% have Hb. A 1 c>10. 0 % 9. 5 9. 0 20. 2% have Hb. A 1 c>9. 0 % 8. 5 8. 0 37. 2% have Hb. A 1 c>8. 0 % 7. 5 64. 2% of patients with type 2 diabetes have Hb. A 1 c≥ 7. 0 % 7. 0 6. 5 6. 0 5. 5 Adapted from Unger et al. Am Slide No J 7 Med 2008; 121: S 3–S 8. *

Insulin therapy with Novo. Mix® 30 Current glycaemic targets • Current Hb. A 1 c goals include: – ADA, EASD, IDF: <7% – AACE, JDS: ≤ 6. 5% • Current pre- and postprandial glucose goals include: ADA • Pre-meal: 90– 130 mg/d. L • Peak. PP: <180 mg/d. L IDF • Pre-meal: <110 mg/d. L • 1– 2 -h peak: <160 mg/d. L Slide No 8 AACE, American Association of Clinical. Endocrinologists; JDS, Japan Diabetes Society *

Insulin Initiation • Basal • Premixed • Basal- bolus

Analogue versus human insulin

Insulin therapy with Novo. Mix® 30 Formulation of premixes Premixed suspension of: Soluble insulin aspart 30% Soluble human insulin NPH Protamine-crystallised insulin aspart Novo. Mix® 30 Premixed human insulin Slide No 11 *

Insulin therapy with Novo. Mix® 30 Increasing complexity of insulin regimens ADA/EASD Position Statement. Diabetologia Online; February Slide 24 No 12 2012 *

Insulin therapy with Novo. Mix® 30 is a solution Slide No 13 *

Diabetes Care 2013 Insulin therapy with Novo. Mix® 30 Slide No 14 *

Diabetes Care 2013 Insulin therapy with Novo. Mix® 30 Slide No 15 *

CONCLUSION: Biphasic and basal bolus regimens were equally effective in reducing Hb. A 1 c in insulin naïve patients with T 2 DM and both regimens are equally effective for initiating insulin in T 2 DM. Wang C 1, Mamza J, Idris I. Diabetic Medicine. 2015 Jan 16

Novo. Mix® 30 or Mixed Human Insulin therapy with Novo. Mix® 30 Slide No 17 *

The dual-release insulin concept: BHI 30 Insulin therapy with Novo. Mix® 30 • Physiological insulin profile: basal component meal-related peaks • Soluble insulin fails to match normal insulin peak • Intermediate-acting insulin provides basal insulin replacement but… Physiological insulin profile Soluble human insulin • NPH …together these fail to re-create the physiological insulin profile BHI 30 Slide No 18 *

The dual-release insulin concept Insulin therapy with Novo. Mix® 30 • Physiological insulin profile: basal component meal-related peaks • Rapid-acting insulin analogues together with a basal insulin provide physiological insulin replacement Physiological insulin profile • Premix analogues such as Novo. Mix® 30 replace both meal-related and basal insulin Soluble insulin aspart Protamine crystallised insulin aspart Novo. Mix® 30 Slide No 19 *

Insulin therapy with Novo. Mix® 30 Overall hypoglycaemia rate following switch from biphasic human insulin to biphasic aspart n=6323 El Naggar et al. Diabetes Res Clin Pract 2012; 98: 408– 13 Slide No 21 *

Insulin therapy with Novo. Mix® Diabetes Care 2013 30 Slide No 22 *

Insulin therapy with Novo. Mix® 30 Slide No 23 *

Intensifying from BIAsp 30 BID to TID BIAsp, biphasic insulin aspart; BID, twice daily; OD, once daily; TID, three-times daily; TZDs, thiazolidinediones Unnikrishnan et al. Int J Clin Pract 2009; 63: 1571– 7

Insulin therapy with Novo. Mix® 30: Conclusion Slide No 25 *

Insulin therapy with Novo. Mix® 30 • Improve Glycaemic Control • Improve Safety Profile • Improve Convenience In one Insulin, one Device Slide No 26 *

Insulin therapy with Novo. Mix® 30 “Always aim at complete harmony of thought and word and deed” Gandhi Aim at complete harmony of Patient and Physician and Prescription Slide No 27 *

Any Question? Insulin therapy with Novo. Mix® 30 Slide No 28 *