Table 2.

Benefits and drawbacks of biphasic insulin analogues use in patients with Type 2 diabetes.

Benefits Provide both basal and prandial insulin dosing in one injection A convenient option for initiating insulin therapy as either once or twice daily injections in patients who are using other anti-diabetic agents and not achieving glycaemic targets A possible option to consider when glycaemic goals are not being achieved with basal insulin alone Provide better control of postprandial hyperglycaemia than non-insulin agents or basal-only insulin regimens Reduce risk of severe hypoglycaemia compared with premixed human insulin Good patient acceptance (easy to time with meals, availability of dual-action profile insulin in one injection, no mixing of short and long-acting insulins) Reduce errors in dosing that may occur when using different types of insulin as separate or self-mixed injections with either syringes or pens

Drawbacks Dosage of the two types of insulin components cannot be adjusted separately Regimens based on carbohydrate counting and sensitivity factor are hard to devise with premixed insulin analogues Difficulty when used as supplemental insulin in place of rapid-acting insulin alone for acute treatment of hyperglycaemia Insulin coverage may not address the dawn phenomenon, early-morning hyperglycaemia, and post-lunch hyperglycaemia Not suitable when food intake is held (for example, in hospitalised patients)