Ryzodeg has benefits over basal bolus in type 2 diabetes

Novo Nordisk’s latest mixed insulin, Ryzodeg, failed to outperform a basal bolus insulin regimen but displayed benefits that may make it a superior candidate for people with type 2 diabetes.
Ryzodeg is a mixed insulin consisting of 70% Tresiba (insulin degludec) and 30% NovoRapid (insulin aspart). In the clinical trial, it was tested against a basal-bolus insulin regimen consisting of taking Tresiba as the basal (background) insulin and separate bolus (before meal) injections of NovoRapid.
The results of the 26 week study showed that the new mixed insulin Ryzodeg was narrowly outperformed by the basal-bolus insulin regimen in terms of HbA1c. On the basal-bolus therapy, participants achieved an average HbA1c of 51 mmol/mol (6.8%) and users of the new Ryzodeg achieved an average HbA1c of 53 mmol/mol (7.0%).
Whilst Ryzodeg was edged in terms of HbA1c, participants experienced 20% less night time hypos than the participants on a basal-bolus regimen and 19% less hypos overall. In addition, users of Ryzodeg had lower daily doses of insulin and gained less weight as a result. The other key benefit of Ryzodeg is that it requires fewer injections. Whilst a basal bolus regimen typically requires up to 4 injections per day, Ryzodeg need only be injected once or twice per day.
Mixed insulin is not a new concept. Previously, mixed insulin has involved a mix of a short or rapid acting form of insulin that is mixed with an intermediate acting insulin. However, because intermediate acting insulin lacks the flat profile that long-acting analogue insulin has, this increases the risk of night time hypos occurring. Ryzodeg, however, uses an ultra-long acting analogue insulin (Tresiba) which has a flat profile and therefore results in more stable sugar levels through the night, reducing the risk of hypos.
In reducing the number of injections and hypos, Ryzodeg is likely to be an attractive proposition for people with type 2 diabetes that find regular insulin injections difficult to manage, notably for elderly people.