OBJECTIVES: A network meta-analysis (NMA) was conducted to compare the efficacy and safety outcomes of insulin icodec with other basal insulins for the management of patients with type 2 diabetes (T2D) switching basal insulin in a basal-bolus regimen, 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) 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 resulted in numerically greater HbA_1c reductions compared with insulin detemir, with a treatment difference of −0.27% (95% credible interval [Crl]; −0.56, 0.02]), and numerically lower HbA_1c reductions compared with IGlar U100 (0.02% [95% Crl; −0.12, 0.16]) and IGlar U300 (0.04% [95% Crl; −0.14, 0.22]). No comparable HbA_1c data were available for change from baseline in HbA_1c at 26 ± 4 weeks with insulin degludec. Treatment with insulin icodec resulted in numerically lower odds of clinically significant hypoglycaemia compared with IGlar U100 (odds ratio, 0.85 [95% Crl; 0.61, 1.17]), and numerically greater odds of clinically significant hypoglycaemia compared with IGlar U300 (odds ratio, 1.04 [95% Crl; 0.68, 1.60]). No comparable data were available for clinically significant hypoglycaemia at 26 ± 4 weeks with insulin detemir.

CONCLUSIONS: For patients with T2D switching basal insulin in a basal-bolus regimen, insulin icodec resulted in no significant change in HbA_1c, or proportion of patients experiencing clinically significant hypoglycaemic events, at 26 ± 4 weeks compared with other basal insulins.