15 Years of Experience with Biphasic Insulin Aspart 30 in Type 2 Diabetes

Abstract

Since clinical experience with biphasic insulin aspart 30 (BIAsp 30) in type 2 diabetes mellitus (T2DM) was reviewed in 2012 after 10 years of use worldwide, additional studies have been published that highlight new aspects, including use in real-world populations. Evidence from 35 new studies confirms and builds upon previous work indicating that BIAsp 30 continues to have pharmacodynamic and clinical advantages over biphasic human insulin (BHI 30), including in real-world practice with unselected populations of patients. BIAsp 30 has also been shown to be safe and efficacious as an add-on to dipeptidyl peptidase-4 (DPP-4) inhibitors. Intensification with BIAsp 30 is a safe and effective way to improve glycemic control, and titration performed by patients can achieve results that are at least comparable to those when being guided by healthcare providers. Stepwise intensification using BIAsp 30 is comparable to intensification using a basal-bolus regimen, and twice-daily BIAsp 30 provides similar glycemic control to a basal-plus regimen. Data from large observational studies, in particular, have identified patient-related characteristics that are associated with improved clinical responses, suggesting that earlier initiation and intensification of therapy is warranted. Finally, new health-economic analyses continue to confirm that BIAsp 30 is cost effective versus other therapies such as BHI 30, neutral protamine Hagedorn (NPH), or insulin glargine in both insulin-naïve and insulin-experienced patients. After 15 years of clinical use worldwide, analysis of more recent 5-year data indicates that BIAsp 30 remains a safe, effective, and simple-to-use insulin for initiation and intensification by diabetes specialists and primary care physicians in a variety of patients with T2DM.

Fig. 1

Average glucose profile during BHI 30 or BIAsp 30 treatment using 48-h continuous glucose monitoring [2]. BB before breakfast (− 0.5 to 0 h), BD before dinner (− 0.5 to 0 h), BHI 30 biphasic human insulin 30, BIAsp 30 biphasic insulin aspart 30, BL before lunch (– 0.5 to 0 h). *p < 0.05. Republished from Ohta et al. [2] with permission of John Wiley and Sons Inc.

Fig. 2

Meta-analysis showing weighted mean difference in glycated hemoglobin (HbA_1c) for BIAsp 30 versus IGlar across five randomized controlled trials [5]. BIAsp 30 biphasic insulin aspart 30, BID twice daily, CI confidence interval, IGlar insulin glargine, OD once daily, WMD weighted mean difference. Republished from Rys et al. [5] with permission of John Wiley and Sons Inc.