Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia.
- Resource Type
- Academic Journal
- Authors
- Chan SP; MBBS (Mal) FRCP (Edin), AM (Mal), Consultant Endocrinologist, University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, Selangor, Malaysia. Email: spchan88@hotmail.com.; Mumtaz M; MBBS (USM), MRCP (UK), FRCP (Edinburgh, Glasgow), Island Hospital Penang, 308, Jalan Macalister, George Town, Pulau, Pinang, Malaysia.; Ratnasingam J; MMed (UM), Fellowship in Endocrinology (Australia), MD (UKM), University of Malaya, Jln Profesor, Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Tan ATB; MB ChB (Liverpool), MRCP (UK), FRCP (Edinburgh), Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, Selangor, Malaysia.; Lim SC; DM (UKM), MRCP (UK), Fellowship in Endocrinology (Malaysia), Mahkota Medical Centre, No 3, Mahkota Melaka, Jln Merdeka, Melaka, Malaysia.; Rosman A; MD (UM, Mal), MRCP (UK), FNHAM (MAl), FAPSIC (Asia Pacific), FAsCC (ASEAN), FESC (EU), FACC (US), Institut Jantung Negara,145, Jln Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Chee KH; NHAM, MMed (Mal), MBBS (UM), University of Malaya, Jln Profesor, Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Lim SK; AM (MAL), FRCP(Edin), MBBS(MAL), MRCP(UK), University of Malaya, Jln Profesor, Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.; Yew SS; MBBS (UM), MRCP (UK), Mahkota Medical Centre, No 3, Mahkota Melaka, Jln Merdeka, Melaka, Malaysia.; Mohd Yusof BN; BS (Diabetics; UKM), Ph.D (UKM), Universiti Putra Malaysia, Jalan, Universiti 1 Serdang, Seri Kembangan, Selangor, Malaysia.; Lau BK; MD (USM), MRCP (UK), KPJ Kuching Specialist Hospital, Lot 18807, Block 11 Muara Tebas, Land District, Jln Stutong, Kuching, Sarawak, Malaysia.; Kassim SB; MB BCh BAO (NUIG), PGCMedEd (QUB), MRCP (U.K.), FRCP (Lon), FRCP (Glasg) FRCPI (Ire) FRCP (Edin), CCST (JRCPTB U.K. Endocrinology & Diabetes; Internal Medicine), Gleneagles Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur, Malaysia.; Mohamed M; MBBS (Adelaide), MRCP (UK), MMedSci (University of Sheffield), FRCP (Edinburgh), Universiti Sains Malaysia Hospital, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
- Source
- Publisher: Academy of Family Physicians of Malaysia Country of Publication: Malaysia NLM ID: 101466855 Publication Model: eCollection Cited Medium: Print ISSN: 1985-207X (Print) Linking ISSN: 19852274 NLM ISO Abbreviation: Malays Fam Physician Subsets: PubMed not MEDLINE
- Subject
- Language
- English
- ISSN
- 1985-207X
Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naive or insulin-naive patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal-bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%-50% and taken during sahur, while the preRamadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp.
Competing Interests: The authors declare that they have no conflicts of interest related to the publication of this article.
(© Academy of Family Physicians of Malaysia.)