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This review provides expert opinion on the practical clinical use of IDegAsp, including: dose timings relative to meals, when and how to intensify treatment from once\u2010daily (OD) to twice\u2010daily (BID) dose adjustments, and use in special populations (including hospitalized patients). IDegAsp could be considered as one among the choices for initiating insulin treatment, preferential to starting on basal insulin alone, particularly for people with severe hyperglycaemia and\/or when postprandial hyperglycaemia is a major concern. The recommended starting dose of IDegAsp is 10\u2009units with the most carbohydrate\u2010rich meal(s), followed by individualized dose adjustments. Insulin doses should be titrated once weekly in two\u2010unit steps, guided by individualized fasting plasma glucose targets and based on patient goals, preferences and hypoglycaemia risk. Options for intensification from IDegAsp OD are discussed, which should be guided by HbA1c, prandial glucose levels, meal patterns and patient preferences. Recommendations for switching to IDegAsp from basal insulin, premixed insulins OD\/BID, and basal\u2010plus\/basal\u2013bolus regimens are discussed. IDegAsp can be co\u2010administered with other antihyperglycaemic drugs; however, sulphonylureas frequently need to be discontinued or the dose reduced, and the IDegAsp dose may need to be decreased when sodium\u2010glucose co\u2010transporter\u20102 inhibitors or glucagon\u2010like peptide\u20101 receptor agonists are added. Considerations around the initiation or continuation of IDegAsp in hospitalized individuals are discussed, as well as in those undergoing medical procedures.<\/jats:p>","DOI":"10.1111\/dom.14128","type":"journal-article","created":{"date-parts":[[2020,7,3]],"date-time":"2020-07-03T07:53:51Z","timestamp":1593762831000},"page":"1961-1975","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Practical use of insulin degludec\/insulin aspart in a multinational setting: beyond the guidelines"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2509-8054","authenticated-orcid":false,"given":"Roopa","family":"Mehta","sequence":"first","affiliation":[{"name":"Unidad de Investigaci\u00f3n en Enfermedades Metab\u00f3licas, Departamento de Endocrinolog\u00eda y Metabolismo Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology St Vincent\u02bcs Hospital  Sydney Australia"},{"name":"University of New South Wales, Office of Medical Education University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahisa","family":"Hirose","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Metabolism and Endocrinology, Department of Medicine Toho University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6435-7995","authenticated-orcid":false,"given":"Mathew","family":"John","sequence":"additional","affiliation":[{"name":"Providence Endocrine and Diabetes Specialty Centre  Thiruvananthapuram Kerala India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adri","family":"Kok","sequence":"additional","affiliation":[{"name":"Netcare Union and Clinton Hospitals  Alberton South Africa"},{"name":"University of Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Department of Endocrinology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambika Gopalakrishnan","family":"Unnikrishnan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Chellaram Diabetes Institute  Pune Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilek Gogas","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Marmara University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Fulcher","sequence":"additional","affiliation":[{"name":"Northern Clinical School University of Sydney  Sydney Australia"},{"name":"Department of Diabetes, Endocrinology &amp; Metabolism Royal North Shore Hospital, University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,12]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-018-0395-3"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.06.011"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-014-0067-x"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-016-0455-7"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2011.01395.x"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.49.12.2142"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.5.1107"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2008.0019"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-015-0106-2"},{"key":"e_1_2_13_11_1","unstructured":"Novo Nordisk A\/S. 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