OBJECTIVES: A systematic literature review (SLR) was conducted to identify randomized controlled trials (RCTs) examining treatments of interest in the management of patients with type 2 diabetes (T2D). RCTs identified in the SLR were assessed to determine the feasibility of comparing insulin icodec with other basal insulins using network meta-analysis (NMA).

METHODS: Electronic databases (including MEDLINE, Embase, and the Cochrane Library) were searched via the OVID platform in September 2021, with an update in October 2023. Included patients had T2D, treated with insulin glargine (IGlar U100, IGlar U300), insulin detemir, insulin degludec, or insulin icodec. Subpopulations of interest included insulin-naïve patients, and those switching from basal or basal-bolus insulin regimens. Eligible outcomes included change in HbA_1c from baseline, and incidence of hypoglycemic events. A feasibility assessment (FA) was conducted, with studies identified in the SLR assessed for eligibility for inclusion in evidence networks. Study design, patient age, gender, ethnicity, and weight distributions were assessed for heterogeneity.

RESULTS: Of 180 studies extracted in the SLR (insulin naïve T2D, n=124; T2D basal switch population, n=37; T2D basal-bolus switch population, n=19), 22 met the criteria for the FA. For insulin naïve patients with T2D, 14 studies were eligible for NMA, with analyses at 26±4 weeks and 52±4 weeks for all treatments of interest. For patients with T2D switching from basal insulin, five studies were relevant for NMA, with analyses at 26±4 weeks for all treatments of interest except insulin detemir. For patients with T2D in basal-bolus regimens, three studies were relevant for NMA, with analyses at 26±4 weeks for all treatments of interest except insulin degludec. Trial heterogeneity was limited in all groups.

CONCLUSIONS: A NMA was feasible for outcomes of interest at 26±4 weeks for the T2D basal switch and basal-bolus switch populations, and at 26±4- and 52±4- weeks for the T2D insulin naïve population.