Intensification lessons with modern premixes: From clinical trial to clinical practice

This paper aims to underscore the importance of insulin intensification, while highlighting the clinical utility of modern premixes through intensification lessons, by utilising data from key clinical trials, and from the recently published large observational PRESENT Study. Insulin intensification is any change made to an initial insulin regimen to improve glycaemic control. Yet, despite established glycaemic targets, current HbA1c levels in insulin-treated patients suggest that ‘real-world’ insulin regimens are not optimally intensified. When treatment is intensified as needed, patients are more likely to achieve and maintain glycaemic targets, as evidenced by treat-to-target trials utilising forced titration algorithms. Both clinical and observational studies suggest that modern premixes, such as biphasic insulin aspart 30, represent an effective and well-tolerated option when intensifying a number of existing insulin regimens that no longer maintain optimal glycaemic control. However, physician and patient concerns regarding initiation and intensification of insulin therapy can create barriers to effective patient care, and it is essential that such barriers be resolved. Although it is important to encourage patients to initiate insulin therapy when needed, it is equally important that insulin regimens benefit from ongoing intensification in order to maintain glycaemic control as type 2 diabetes follows its typically progressive course.