Glycemic control and weight loss benefits of fixed-ratio combinations of basal insulins and GLP1 receptor agonists in type 2 diabetes: A systematic review and network meta-analysis.
A B M Kamrul-Hasan, Sunetra Mondal, Lakshmi Nagendra et al.
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In 30 seconds
This systematic review and network meta-analysis compared fixed-ratio combinations of basal insulin and GLP-1 receptor agonists with basal insulin alone in adults with type 2 diabetes. It included 30 randomised trials involving 17,862 participants. All combinations improved HbA1c and body weight relative to basal insulin alone. HR17031 had the largest estimated HbA1c reduction (mean difference [MD]: -0.72%), while IcoSema had the largest estimated weight reduction (-3.16 kg). These rankings are hypothesis-generating: evidence was mostly low to moderate certainty for comparisons with basal insulin and often low to very low certainty for indirect comparisons between active regimens.
Key findings
- All fixed-ratio combinations reduced HbA1c and body weight more than basal insulin alone.
- HR17031 had the largest estimated HbA1c reduction versus basal insulin (MD: -0.72%); differences from other combinations were not statistically significant.
- IcoSema had the largest estimated weight reduction versus basal insulin (-3.16 kg); differences from other combinations were not statistically significant.
- Compared with basal insulin, combinations increased achievement of HbA1c < 7%, often without weight gain or clinically significant/severe hypoglycemia.
Why it matters
Combining basal insulin with a GLP-1 receptor agonist may address glycemic control and weight outcomes together in adults with type 2 diabetes. The analysis also indicates that apparent rankings among combinations should not be treated as established comparative advantages: certainty was limited, particularly for indirect comparisons between active regimens.
What to keep in mind
The authors report heterogeneity, inconsistency, and limited certainty of indirect evidence; certainty was predominantly low to moderate for comparisons with basal insulin and low to very low for many comparisons among active regimens.