OBJECTIVES: A network meta-analysis (NMA) was conducted to compare the efficacy and safety of insulin icodec with other basal insulins for the management of patients with type 2 diabetes (T2D) switching from basal insulin, based on studies identified through a systematic literature review (SLR).

METHODS: A SLR was conducted in October 2023 to identify relevant randomised controlled trials (RCTs) examining treatments of interest (insulin icodec, insulin glargine [IGlar U100, IGlar U300], insulin detemir, and insulin degludec [U100 and U200]) in this population. Data at 26 ± 4 weeks were extracted for efficacy and safety outcomes including change from baseline in glycated haemoglobin (HbA_1c) and proportion of patients with clinically significant hypoglycaemic events. Fixed- and random-effects NMA were fitted in a Bayesian setting.

RESULTS: Treatment with insulin icodec was associated with significantly greater HbA_1c reductions compared with insulin degludec U100, (−0.22% [95% credible interval {Crl}; −0.37, −0.08]), and numerically greater HbA_1c reductions compared with insulin degludec U200 (−0.11% [95% Crl; −0.33, 0.11]), and IGlar U100 (−0.17% (95% Crl; -0.44, 0.10) and U300 (−0.16% [95% Crl; −0.39, 0.07]). Treatment with insulin icodec was associated with significantly higher odds of clinically significant hypoglycaemia compared with insulin degludec U100 (odds ratio, 2.13 [95% Crl; 1.20, 3.91]), and numerically higher odds compared with insulin degludec U200 (odds ratio, 1.93 [95% Crl; 0.95, 4.01]). No comparable data were available for change from baseline in HbA_1c with insulin detemir, or for proportion of patients with clinically significant hypoglycaemic events with IGlar U100, U300, or insulin detemir.

CONCLUSIONS: For patients with T2D switching from basal insulin, insulin icodec resulted in greater HbA_1c reductions at 26 ± 4 weeks compared with other basal analogs. Insulin icodec was associated with an increased risk of hypoglycaemic events compared with two comparators. However, data for hypoglycaemic events was limited.