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J Assoc Physicians India. 2017 Apr;65(4):59-73.

Consensus on Initiation and Intensification of Premix Insulin in Type 2 Diabetes Management.

Author information

Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu.
Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana.
Chairman and Managing Director at Jothydev's Diabetes Research Centre, Trivandrum, Kerala.
Consultant Endocrinologist, GD Hospital and Diabetes Institute, Kolkata, and Sun Valley Diabetes Research Center, Guwahati, Assam.
Diabetes Care and Research Centre, Near Overbridge, Kankarbagh, Patna, Bihar.
Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Lalani Quantum, Bavdhan Budruk, Pune, Maharashtra.
Department of Diabetology, North Delhi Diabetes Centre and Department of Medicine, Maharaja Agrasen Hospital, New Delhi.
Endocrinologist, Apollo Gleneagles Hospital Limited, Kolkata, West Bengal.
Department of Endocrinology and Diabetes, Apollo Gleneagles.
Consultant Diabetologist, Apollo Sugar Clinic and Professor, Department of Medicine, SRM Medical College and Research Institute, Kattankulathur, Chennai, Tamil Nadu.
Diabetes Care Mumbai, Maharashtra and SL Raheja Hospital (Fortis Associate Hospital) Mumbai, Maharashtra.
Arthur Asirvatham Hospital, Madurai, Tamil Nadu.
Wellbeing, Cuttack, Orissa; SCB Medical College, Cuttack, Orissa and SARP Multispeciality Hospital, Cuttack, Orissa.
Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir.
Professor of Medicine and Professor and Head of Endocrinology, Pondicherry Institute of Medical Sciences, Dhanvantri Nagar, Gorimedu, Puducherry.



Premix insulin is the most commonly used insulin preparation in India. The first Indian premix guidelines were developed in 2009 and thereafter were updated in 2013. There is a need to revisit the Indian premix insulin guidelines, in view of emerging evidence and introduction of newer co-formulations.


The present consensus has been developed to evaluate available premix formulations, examine existing evidence related to premix formulations, and evolve consensus statement of recommendations on the topic.


A meeting of experts from across India was conducted at Chennai in July 2016. The expert committee evaluated each premix insulin regimen with reference to 1) Current recommendations by various guidelines, 2) Approved pack inserts and 3) Published scientific literature. The information was debated and discussed within the expert group committee, to arrive at seven consensus-based recommendations for initiation and intensification with premix insulin.


Recommendations based on consensus on initiation and intensification of premix insulin in type 2 diabetes mellitus (T2DM) management were developed for the following situations. 1) Initiation of premix insulin co-formulation at diagnosis, 2) Initiation of once daily (OD) premix insulin/co-formulation, 3) Initiation of twice daily (BID) premix insulin/co-formulation 4) Intensification with BID and thrice daily (TID) premix insulin/co-formulation. Three recommendations pertained to the use of premix insulin in other forms of diabetes, or in specific situations: 5) Use of premix insulin in gestational diabetes mellitus 6) Use of premix insulin in type 1 Diabetes Mellitus (T1DM) 7) Premix insulin use during Ramadan.


In the setting of high carbohydrate consumption in India, or in patients with predominant post prandial hyperglycemia, premix insulin/co-formulation can offer effective and convenient glycemic control. This paper will help healthcare practitioners initiate and intensify premix insulin effectively.

[Indexed for MEDLINE]

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