Real-world data on transitioning from premixed insulin to fixed-ratio injectable therapies in type 2 diabetes mellitus (T2DM) remain limited. A retrospective cohort study published in Diabetic Medicine evaluated the efficacy and safety of switching from premixed insulin to a fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist in adults with T2DM.

The study included 40 individuals (mean age 67.6 ± 10.5 years) who transitioned therapy between July 2020 and July 2023. Glycemic parameters were assessed at baseline, 3 months, and 6 months. Among those with baseline glycated hemoglobin (HbA1c) >58 mmol/mol (7.5%), HbA1c decreased from 79 ± 18 mmol/mol (9.4% ± 1.7%) to 67 ± 18 mmol/mol (8.2% ± 1.6%) at 6 months (p=0.01), and 23.1% achieved HbA1c ≤53 mmol/mol (7.0%). The greatest HbA1c reduction was observed in those previously receiving 40–50 units/day of premixed insulin.

Total insulin dose and injection frequency were significantly reduced after transition (p<0.001). Hypoglycemia incidence decreased from 60.0% to 12.5% (p<0.001). Among individuals with pre-existing hypoglycemia, glycemic control remained stable despite reductions in insulin dose and injection frequency (p=0.001 and p=0.032, respectively). Higher homeostatic model assessment of insulin resistance (HOMA-IR) was associated with suboptimal glycemic response in multivariable analysis (p=0.037).

These findings indicate that transitioning from premixed insulin to a fixed-ratio combination therapy is associated with improved glycemic control and reduced treatment burden in a real-world setting.