CPG UPDATE - Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia

Siew Pheng Chan; Malik Mumtaz; Jeyakantha Ratnasingam; Alexander Tong Boon Tan; Siang Chin Lim; Azhari Rosman; Kok Han Chee; Soo Kun Lim; Shiong Shiong Yew; Barakatun-Nisak Mohd Yusof; Bik Kui Lau; Saiful Bahari Kassim; Mafauzy Mohamed

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CPG UPDATE - Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia

Author: Siew Pheng Chan ¹ ; Malik Mumtaz ² ; Jeyakantha Ratnasingam ³ ; Alexander Tong Boon Tan ⁴ ; Siang Chin Lim ⁵ ; Azhari Rosman ⁶ ; Kok Han Chee ⁷ ; Soo Kun Lim ⁸ ; Shiong Shiong Yew ⁹ ; Barakatun-Nisak Mohd Yusof ^{10
,

11} ; Bik Kui Lau ¹² ; Saiful Bahari Kassim ^{13
,

14
,

15} ; Mafauzy Mohamed ¹⁶
Author Information

1. MBBS (Mal) FRCP (Edin), AM (Mal) Consultant Endocrinologist, University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, Selangor, Malaysia.
2. MBBS (USM), MRCP (UK), FRCP (Edinburgh, Glasgow) Island Hospital Penang, 308, Jalan Macalister, George Town, Pulau Pinang, Malaysia.
3. MMed (UM), Fellowship in Endocrinology (Australia), MD (UKM) University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
4. MB ChB (Liverpool), MRCP (UK), FRCP (Edinburgh) Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, Selangor, Malaysia.
5. DM (UKM), MRCP (UK), Fellowship in Endocrinology (Malaysia) Mahkota Medical Centre, No 3, Mahkota Melaka, Jln Merdeka, Melaka, Malaysia.
6. 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.
7. NHAM, MMed (Mal), MBBS (UM) University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
8. AM (MAL), FRCP(Edin), MBBS(MAL), MRCP(UK) University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
9. MBBS (UM), MRCP (UK) Mahkota Medical Centre, No 3, Mahkota Melaka, Jln Merdeka, Melaka, Malaysia.
10. BS (Diabetics
11. UKM), Ph.D (UKM) Universiti Putra Malaysia, Jalan Universiti 1 Serdang, Seri Kembangan, Selangor, Malaysia.
12. MD (USM), MRCP (UK) KPJ Kuching Specialist Hospital, Lot 18807, Block 11 Muara Tebas Land District, Jln Stutong, Kuching, Sarawak, Malaysia.
13. MB BCh BAO (NUIG), PGCMedEd (QUB), MRCP (U.K.), FRCP (Lon) FRCP (Glasg) FRCPI (Ire) FRCP (Edin), CCST (JRCPTB U.K. Endocrinology &
14. Diabetes
15. Internal Medicine) Gleneagles Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
16. 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.
Publication Type:Journal Article
Keywords: Insulin degludec; Insulin aspart; Glucose; Hypoglycaemia; Type 2 diabetes mellitus
MeSH: insulin degludec [Supplementary Concept]; Insulin Aspart; Glucose; Hypoglycaemia; Diabetes Mellitus, Type 2
From:Malaysian Family Physician 2023;18(All Issues):1-12
CountryMalaysia
Language:English
Abstract: 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-naïve or insulin-naïve 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 pre-Ramadan 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.
Full text:202508211315231557718.31R1CPGPracticalguideinusinginsulindegludec.pdf