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 insulin naïve patients with type 2 diabetes (T2D), based on studies identified through a systematic literature review (SLR).

METHODS: A SLR was conducted in October 2023 to identify randomised controlled trials (RCTs) examining treatments of interest (insulin icodec, insulin glargine [IGlar U100, IGlar U300], insulin detemir, and insulin degludec) in this population. Where possible, data at 52 ± 4 weeks were extracted for outcomes selected for the NMA including change from baseline in glycated haemoglobin (HbA_1c), and proportion of patients with clinically significant hypoglycaemic events. However, in some cases, comparisons were only possible at 26 ± 4 weeks. Fixed- and random-effects NMA were fitted in a Bayesian setting.

RESULTS: Treatment with insulin icodec was associated with significantly greater HbA_1c reductions at 52 ± 4 weeks compared with IGlar U100, insulin detemir, and insulin degludec U100, with treatment differences of −0.19% (95% credible interval [Crl]; −0.35, −0.03), −0.24% (95% Crl; −0.47, −0.01), and −0.28% (95% Crl; −0.49, −0.07), respectively. Treatment with insulin icodec was associated with numerically greater HbA_1c reductions at 26 ± 4 weeks compared with IGlar U300, with a treatment difference of −0.19% (95% Crl; −0.49, 0.1). Treatment with insulin icodec was associated with numerically lower odds of clinically significant hypoglycaemia at 52 ± 4 weeks compared with IGlar U100 (odds ratio, 0.91 [95% Crl; 0.60, 1.38]) and insulin degludec U100 (odds ratio, 0.91 [95% Crl; 0.55, 1.50]).

CONCLUSIONS: Insulin naïve patients with T2D had significantly greater HbA_1c reductions at 52 ± 4 weeks with insulin icodec compared with IGlar U100, insulin detemir and insulin degludec, with no increased risk of hypoglycaemic events.