Xia Y, Hu Y, Ma JH. Premixed insulin: Advantages, disadvantages, and future. World J Diabetes 2025; 16(3): 102526 [DOI: 10.4239/wjd.v16.i3.102526]
Corresponding Author of This Article
Jian-Hua Ma, MD, Professor, Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 32 Gongqingtuan Road, Nanjing 210000, Jiangsu Province, China. majianhua@china.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Mar 15, 2025; 16(3): 102526 Published online Mar 15, 2025. doi: 10.4239/wjd.v16.i3.102526
Premixed insulin: Advantages, disadvantages, and future
Yan Xia, Yun Hu, Jian-Hua Ma
Yan Xia, Yun Hu, Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
Jian-Hua Ma, Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Co-first authors: Yan Xia and Yun Hu.
Author contributions: Hu Y and Xia Y drafted the initial manuscript; Ma JH conceptualized and revised the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Hua Ma, MD, Professor, Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No. 32 Gongqingtuan Road, Nanjing 210000, Jiangsu Province, China. majianhua@china.com
Received: October 21, 2024 Revised: December 30, 2024 Accepted: January 8, 2025 Published online: March 15, 2025 Processing time: 92 Days and 18 Hours
Abstract
Premixed insulin combines two types of insulin in a single injection. This combination streamlines dosing for patients with type 1 or type 2 diabetes, thereby enhancing convenience. However, patients receiving premixed insulin commonly have less satisfactory blood glucose control. The fixed ratio of insulin in these formulations frequently fails to account for the nuanced demands of individualized glucose-lowering therapy. Moreover, local absorption of mixed insulin and potential systemic autoimmune responses may further compromise glycaemic control. The co-formulation of insulin degludec and insulin aspart introduces a new combination of the two insulin types within a single injection, offering a promising solution for mitigating the limitations inherent in premixed insulin.
Core Tip: Premixed insulin improved patient adherence because of its simplified treatment regimens, fewer injections, and low price. Therefore, premixed insulin is widely used, especially in developed countries. However, patients receiving premixed insulin commonly have less satisfactory blood glucose control. The fixed ratio of premixed insulin usually fails to meet the nuanced demands of individualized glucose-lowering therapy. Moreover, aberrant local absorption and potential systemic autoimmune responses of premixed insulin may further affect glycemic control. New insulin formulations offer improved blood glucose control, weight management, and reduced hypoglycemia. Further studies are needed to guide the optimization of insulin use through individualized treatment approaches or to mitigate the side effects of premixed insulin through novel drug combinations.
