Diabetes, obesity & metabolism · 2026
Efficacy and Safety of Once-Weekly and Once-Daily Basal Insulins in Type 1 Diabetes Mellitus: A Systematic Review and Network Meta-Analysis of Clinical Trials.
Систематический обзорNetwork Meta-AnalysisСтатьяНазвание и аннотация: Перевод в очереди
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Amaral Ricardo, Costa Beatriz, Penedones Ana, Mendes Diogo, Alves Carlos
Аннотация
AIMS: Once-weekly basal insulins, icodec and efsitora alfa, were developed to improve treatment adherence and glycemic control and appear to be as effective as once-daily degludec in reducing HbA1c in type 1 diabetes (T1DM). However, higher rates of clinically significant hypoglycemias were associated with both once-weekly insulins. This network meta-analysis compares the efficacy and safety of once-weekly and once-daily basal insulins in T1DM.
METHODS: PubMed and Embase were searched (up to April, 2025) to identify phase 3 clinical trials evaluating basal insulins in T1DM (icodec, efsitora alfa, degludec 100, glargine [100 and 300], detemir, and NPH). Change in HbA1c and weight, risk of hypoglycemias (overall and severe), and serious adverse events (AEs) were assessed at week 26 and 52.
RESULTS: Nineteen studies were included. At week 52, icodec reduced HbA1c more than degludec 100 (-0.17% [95% CrI: -0.28; -0.06]), glargine 100 (-0.17% [95% CrI: -0.32; -0.02]), detemir (-0.17% [95% CrI: -0.32; -0.02]), and NPH (-0.59% [95% CrI: -0.85; -0.34]), while efsitora alfa reduced HbA1c more than NPH (-0.45% [95% CrI: -0.70; -0.19]). Icodec showed a higher overall hypoglycemia risk at week 52 compared with degludec 100 (OR 1.64; 95% CrI 1.07-2.54) and detemir (OR 2.08; 95% CrI 1.01-4.39), but no increased risk of severe hypoglycemias or serious AEs.
CONCLUSIONS: In T1DM, once-weekly basal insulins appear broadly comparable in reducing HbA1c at week 52. Although icodec showed a higher overall hypoglycemia risk, evidence suggests a comparable risk of severe hypoglycemias between treatments.
METHODS: PubMed and Embase were searched (up to April, 2025) to identify phase 3 clinical trials evaluating basal insulins in T1DM (icodec, efsitora alfa, degludec 100, glargine [100 and 300], detemir, and NPH). Change in HbA1c and weight, risk of hypoglycemias (overall and severe), and serious adverse events (AEs) were assessed at week 26 and 52.
RESULTS: Nineteen studies were included. At week 52, icodec reduced HbA1c more than degludec 100 (-0.17% [95% CrI: -0.28; -0.06]), glargine 100 (-0.17% [95% CrI: -0.32; -0.02]), detemir (-0.17% [95% CrI: -0.32; -0.02]), and NPH (-0.59% [95% CrI: -0.85; -0.34]), while efsitora alfa reduced HbA1c more than NPH (-0.45% [95% CrI: -0.70; -0.19]). Icodec showed a higher overall hypoglycemia risk at week 52 compared with degludec 100 (OR 1.64; 95% CrI 1.07-2.54) and detemir (OR 2.08; 95% CrI 1.01-4.39), but no increased risk of severe hypoglycemias or serious AEs.
CONCLUSIONS: In T1DM, once-weekly basal insulins appear broadly comparable in reducing HbA1c at week 52. Although icodec showed a higher overall hypoglycemia risk, evidence suggests a comparable risk of severe hypoglycemias between treatments.