insulin initiation promotional

7/23/2019 Insulin Initiation Promotional

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@ 2015 Eli Lilly and Company

Insulin Initiation and IntensificationWhen Current Therapy Alone No Loner !ro"ides

Ade#uate $lycaemic Control


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7

869ecti"es

/ Identify 6oth the clinical factors and the indi"idualised needs of yourpatient to determine the appropriate insulin therapy reimen

/Apply the clinical e"idence supportin the use of insulin analoue

mi,es to your current practice


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5

Clinical Challene!erson -ith Type 2 &ia6etes on 8ral Therapies 6ut :6A1cIs ;*7 years

?e"ie- of patient lo6oo( sho-s !$

of ;*;1B*% mmolL D1>*22;%*7

mdLF o"er the past 2 months Weiht. 20; l6s D;5 (F

GHI. %1* (m2

Glood pressure. 1%55 mm: Current treatment. lipiide 10 m

J& metformin 1000 m GI& No reported hypolycaemia

Lab Results: !$. 10*7 mmolL D1>*2 mdLF 2hour !!$. 17*> mmolL D2B7*B mdLF

Total cholesterol. 7*> mmolL

D11*5 mdLF Trilycerides. 1*; mmolL D1B*1 mdLF A+T. 15 I'L

ALT. 1; I'L :6A1c. ;*7+50*

-ncretine//ect


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Basal insulinonly

(usually with oralagents)

Non-insulinregimens

Basal insulin +1

(mealtime)rapid-acting

insulininjection

Premixedinsulin twice

daily

Basal insulin +2

(mealtime)rapid-acting

insulininjections

low

mod.

ig

1

2

!+

Num"ero#

injections

$egimencomplexi

ty

%ore &exi"le 'ess&exi"le

lexi"ility

+e#uential Insulin +trateies in

Type 2 &ia6etes

Inucchi +E et al* Diabetes Care* 2012%5DBF.1%B71%>;*


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Treatment +trateies$lucose Triad

/ Treatment stratey should taret all % components

Ceriello A Colaiuri +* Diabet Med. 20025D10F.1151115B*

HbA1c

PP!*P!


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Gasal "s Healtime :yperlycaemia

in &ia6etes

Healthy

ArtistSs renderin 6ased on hypothetical lucose "alues*

?iddle HC* Diabetes Care* 1;;01%DBF.B>BBB*

When .nly 0ealtime Hyperglycaemia -s Corrected7asal hyperglycaemia 0ealtime hyperglycaemia

'2'' 1(''

3ime o/ %ay

14'' (5'' '2''

Plasma!lucose

"mmol#L$

111

&&

'

4)

1)6

(4

Change in A8C /rom healthy basal ;61 mmol#Lhr "15(& mg#dLhr$ 25=


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A hi i :6A1 $ l


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1;

Achie"in :6A1c $oalsComparison of !remi,ed Analoue Insulin -ith Gasal

Insulin Alone

Achieing HbA1c!oal "=$Hypoglycaemia: 7etween,

group Comparison

+tudy:6A1c

$oal

AnaloueHi, GI&

$larine!

"alue8"erall Nocturnal

!AI?!I1

DLillyF >*0< %0< 12< *002 No difference $larineRHi,

!AI?IN2DLillyF

>*0< 72< 1< *001 Hi,R$larine Hi,R$larine

INITIATE%DNo"oF

>*0< BB< 70< *001 Hi,R$larine Not reported

Uan(a=7D+anofi '+F

>*0< %;< 7;< *05;B Hi,R$larine Hi,R$larine

=:uman insulin mi, >0%0 "s larine V 8A&s D+' and HETF*Het K metformin No"o K No"o Nordis( 8A& K oral antidia6etes dru su K sulphonylurea*1* Halone UQ et al* Diabet Med* 200522D7F.%>7%1* 2* Halone UQ et al* Clin Ther. 20072BD12F.20%72077* %* ?as(in ! et al*DiabetesCare. 20052D2F.2B02B5* 7* Uan(a :' et al* DiabetesCare.20052D2F.25725;*


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:umaloHi,25X D25< insulin lispro r&NA oriin3

in9ection >5< insulin lispro protamine suspensionF

/ In people -ithout dia6etes insulin secretion increases1and lucaonle"els are suppressed in response to a meal and G$ is maintained in

a narro- rane2

/ :umalo Hi,25 in a t-icedaily reimen pro"ides 6oth 6asal andrapidactin insulin -hich restores firstphase insulin response in

type 2 dia6etes and suppresses endoenous lucaon production%7

/ !remi,ed insulin tarets 6oth !$ and !!$ concentrations to lo-er:6A1c

/ ?ecent I& uidelines on postprandial control reflect the emerinimportance of postprandial G$ concentrations5

G$ K 6lood lucose I& K International &ia6etes ederation*

1* !olons(y Q+ et al* N Engl J Med* 1;%1D1;F.12%112%;* 2* 'ner ?:* N Engl J Med.1;>125DF.77%77;* %* Gruttomesso & et al* Diabetes.

1;;;7D1F.;;105* 7* ?oach ! Wood-orth U?* Clin Pharmacokinet* 200271D1%F.107%105>* 5* I&* A"aila6le at.

http.---*idf*or-e6datadocs$uideline4!H$4final*pdf* Accessed 2% Auust 201%*


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27

Insulin &ose and Num6er of In9ections at Wee( 7

+&. standard de"iation

3reatment !roups

:umalo Hi,25nK1>>

GGTnK17

Hean insulin dose 'Q D+&F 0*>1 D0*75F 0*>1 D0*7>F

Hean num6er of daily in9ections D+&F 2*17 D0*>5F 2*25 D1*20F

In9ection reimen patients n D; D72*;F

T-o >7 D71*F 20 D10*;F

Three B% D%5*BF 7; D2B*BF

our %B D1;*BF

Go-erin et al* Diabet Med 20122;D;F.e2B%>2*


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Hu"alog 4i=%5 >/ $s >asal nsulin ?largine *nce /aily


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%7

Hu"alog 4i=%5 >/ $s >asal nsulin ?largine *nce /aily@ Hu"alog *nce /ailyu""ary

/ 0oninferiority ( oulation): and then sueriority (TT oulation): of Hu"alog 4i=%5>/ $s. >>T was shown in ter"s of change in HbA1cat %' wees

/ 4ean blood glucose: glycae"ic $ariability: o$erall tolerability: and hyoglycae"ic

eisodes er atient#year did not show signiBcant di


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%5

nitiating Theray with Hu"alog 4i=%5

7tart wit low dose and increase gradually1

0nsulin-na98e patients tart as 1& E subcutaneously () before breafast

and e$ening "eals1

Patients already on once-daily insulin alculate total daily dose Total daily dose F % ?i$e G before breafast and G before e$ening "eal

OAD recommendation: 4aintain at least "etfor"in 1#1.5 g-day in di$ided doses

to sulhonylureaBG measurements:

4onitor re#breafast (fasting) and re#e$ening "eal >?e$ery ,#' days

;*A/s to be used in accordance with the locally aro$ed acage insert. o"e *A/s "ay be contraindicated. hysicians andatients should decide if additional >? "easure"ents "ay be needed.

1. Hirsch >: et al. Clin Diabetes %&&5%,(%)I78#86. %. /J tas force for clinical guidelines. A$ailable athttI--www.idf.org-sites-default-Bles-/J#?uideline#for#Tye#%#/iabetes.df. Accessed %, August %&1,.

atients with Tye % /iabetes on ntensi$e nsulin


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%B

atients with Tye % /iabetes on ntensi$e nsulinTheray Achie$e ?lycae"ic ontrol Esing 5&3>asal and 5&3 >olus (rerandial) nsulin

/ n indi$iduals withoutdiabetes: endogenous

basal insulin secretion

accounts for

aro=i"ately 5&3 of

total daily insulin1

/ atients with tye %

diabetes on intensi$e

insulin theray

regi"ens can achie$e

glycae"ic control using5&3 basal and 5&3

bolus insulin%

;/oses adKusted to achie$e target rerandial and bedti"e >? le$els.1. olonsy L: et al.J Clin Invest.198881(%)I''%#''8. %. Her"an MH: et al. Diabetes Care.%&&5%8(7)I1568#157,.

%ean3o

tala

ily

0nsu

lin

ose

(un

its

)

Basal ose Bolus ose

P.!P.!

,1,*

, ,,

144

,4

4

:ontinuous su"cutaneous insulin in#usion(n,1)%ultiple daily injections (n,*)

0nsulin ose at 5ndpoint2


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li i l h ll


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%;

:ase Presentation; AgeI 5% years /uration of tye % diabetesI 7 years Qe$iew of atient logboo shows J? of 9.9#

16., ""ol- (178.%#%9,.' "g-d) o$er theast % "onths

MeightI %&9 lbs (95 g) >4I ,1.8 g-"%

>lood ressureI 1,5-85 ""Hg urrent treat"entI gliiSide 1& "g D/:

"etfor"in 1&&& "g >/ J?I 1&.' ""ol- (187.% "g-d) %#hour ?I 1'.7 ""ol- (%6'.6 "g-d)

HbA1cI 9.'3

linical hallengeerson on *ral Theraies but HbA1cs 9.'3

Patient Perspecti8e; Mants to i"ro$e glycae"ic control and is willing to add an inKectable

theraybut wants to "ini"ise the nu"ber of inKections

Has a fairly redictable daily routine: including "eal co"osition


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re"i=ed nsulin Analogues $s


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77

re"i=ed nsulin Analogues $s>asal nsulin Analogueshange in HbA1cat ndoint in ' QTs

re"i=ed nsulinI %5#,&3 raid#acting analogue Vnsulin#e=erienced atients. ;PW.&1 ;;PW.&&1.>As ! bihasic insulin asart 7&-,& QT ! rando"ised controlled trial.

/eri$ed fro" 1. Qasin : et al. Diabetes Care.%&&5%8(%)I%6%65. %. Hol"an QQ: et al. N Engl J Med.%&&7,57(17)I1716#17,&.,. 4alone RL: et al. Clin Ther.%&&'%6(1%)I%&,'#%&''. '. 4alone RL: et al. Diabet Med.%&&5%%(')I,7'#,81.

:

ange

in."/

1c

(6)

Basal insulin

Premixed insulin

0nsulin


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