Approaches to switching between insulin product with different insulin active substance

Abstract

In health care emergencies, it may be necessary to switch a patient from one medicine to another to ensure continuity of care and to keep the patient stable. Such a switch can sometimes be difficult to achieve, especially in the case of medical products requiring individualized dose selection, such as insulin preparations. In Russia, there are no clear recommendations for switching from one insulin preparation to another in such situations. For this reason, foreign experience of switching from one insulin product to another was analyzed in conditions when the supply of the patient’s main insulin product was interrupted for various reasons. Based on the results of the literature review, it was found that the practice of replacing an insulin preparation based on one active ingredient with an insulin preparation with another active ingredient or an insulin preparation with a certain ratio of active ingredients with an insulin preparation with the same active ingredients but in a different ratio is quite common abroad. The experience obtained by foreign researchers has been systematized, and based on this work, algorithms have been proposed to help make appropriate replacement or switching decisions. Some of the proposed algorithms were further formalized, and recommendations were developed by well-known foreign agencies involved in the regulation of drug circulation, as well as by the World Health Organization. The results of this analysis may help to develop domestic approaches to insulin product replacement in health care emergencies.