Background
IDegAsp, the first soluble co-formulation which contains 70% basal IDeg and 30% mealtime IAsp, has a unique pharmacodynamic profile. Postprandial and fasting hyperglycemia can be effectively controlled, without increasing the hypoglycemia risk. IDeg component provides a stable basal insulin action over a 24-h period whereas the IAsp component bestows prandial control, which is unaffected by the basal component.

Aims
A retrospective evaluation of the prescription pattern and the clinical outcomes of IDegAsp among T2DM subjects in a real-world setting of Indian clinical practice.

Method
Clinical characteristics and demographics of T2DM subjects prescribed with IDegAsp and on regular follow-up were captured from our EMRs. n=291, age=53.59±11.80years, T2DM duration=11.05±6.28years, 74.14% males, IDegAsp treatment duration (as on 1st April 2018)=10.51±8.53months.
Previous treatment regimen of the patients: (1) OHA only, n=87; (2) OHA+insulin, n=176; (3) OHA+Insulin+GLP1RA, n=7 [3 patients discontinued GLP1RA upon IDegAsp initiation]; (4) Treatment naïve [started on IDegAsp+OHAs, n=17; started on IDegAsp+OHAs+GLP1RA, n=4].

Results
IDegAsp treatment resulted in significant improvement in the clinical profiles. Overall reduction from baseline: FBS -34.93 mg/dL, p<0.0001; PPBS -65.09, p<0.0001; HbA1c -1.470, p<0.0001. Changes in Body weight, BMI and TDD of insulin were non-significant. Negligible number of hypoglycemic episodes reported (0.007 events/ person, none severe, no nocturnal hypos). Initially, 32.88% and 67.12% of the subjects were on IDegAsp once daily(q.d) and twice daily(b.i.d.) respectively. Later, 22.92% of the subjects in the q.d regimen had to be intensified to b.i.d. and 3.57% of the subjects in the b.i.d. were shifted to q.d.

Discussion
In this real-world study of Indian clinical practice, prescription data indicated that the IDegAsp co-formulation is effective across a range of clinical profiles including treatment naïve subjects. It significantly improved clinical outcomes, with negligible hypoglycemia and no weight gain. To a greater extent, IDegAsp could thus help eliminate the concerns regarding insulin intensification such as fear of injections and burdensome regimens, thereby overcome clinical inertia and achieve clinical outcomes in a large proportion of T2DM individuals.

An evaluation of the prescription pattern of IDegAsp and its clinical outcomes in Indian clinical practice