Network meta-analysis

HbA1c below 7 percent

Type 2 diabetes (adults); background therapy: one or more non insulin glucose lowering drugs

weeks 20 to 36 (target week 26)Treatment policyEach dose separatelyOdds ratioSeparate part 2 of a disconnected network

Randomized trials

Treatments

1,292

Participants

849

Events

In plain language

Across 2 trials with 1,292 participants, 0 of 3 treatments had a clearly better result than insulin glargine on HbA1c below 7 percent, 1 a clearly worse one, and for 2 the evidence could not tell them apart from insulin glargine. The most favorable estimate was for IGlarLixi 2:1 pen subcutaneous once daily titrated: odds ratio 2.46 (95% credible interval 0.76 to 7.14).

Higher values favor the treatment. "Clearly" means the 95% credible interval excludes no difference. These are averages across trials; they do not say how any one person will respond. Not medical advice.

Network of trials

Each circle is a treatment; each line joins treatments that were randomized against each other in at least one trial.

Node area shows participants; line width shows trials comparing two treatments directly. Blue: GLP-1 receptor agonist containing treatments; grey: comparators. Hover over or tab to a node or line for details.

Effects compared with Insulin glargine

Odds ratio. Higher values favor the treatment.

Versus Insulin glargine, log scale. Blue: Bayesian random effects posterior median with 95% credible interval (thick) and 95% prediction interval (dashed). Amber diamond: frequentist estimate with 95% confidence interval. Hover over or tab to a row for its values.

Effects of each treatment versus Insulin glargine
Treatment	Bayesian OR (95% CrI)	95% prediction interval	Verdict
IGlarLixi 2:1 pen subcutaneous once daily titrated IGLARLIXI2_SC_TIT_QD	2.46 (0.76 to 7.14)	0.48 to 12.92	Unclear
Insulin degludec and liraglutide (IDegLira) subcutaneous once daily titrated IDEGLIRA_SC_TIT_QD	1.76 (0.49 to 5.51)	0.32 to 9.01	Unclear
Lixisenatide 20 ug subcutaneous once daily LIXI_SC_20UG_QD	0.28 (0.10 to 0.96)	0.06 to 1.73	Worse

Ranking

How likely each treatment is to be among the best. Rankings ignore the size of differences and their certainty, so read them with the effects above.

League table

Every treatment against every other: odds ratio of the row treatment versus the column treatment, posterior median and 95% credible interval. Green: row clearly better; red: row clearly worse.

Every treatment in a row compared with every treatment in a column
Row versus column	INS_GLARGINE	IGLARLIXI2_SC_TIT_QD	IDEGLIRA_SC_TIT_QD	LIXI_SC_20UG_QD
INS_GLARGINE	INS_GLARGINE	0.41 0.14 to 1.31	0.57 0.18 to 2.03	3.53 1.04 to 10.04
IGLARLIXI2_SC_TIT_QD	2.46 0.76 to 7.14	IGLARLIXI2_SC_TIT_QD	1.40 0.27 to 7.58	8.68 2.05 to 26.66
IDEGLIRA_SC_TIT_QD	1.76 0.49 to 5.51	0.71 0.13 to 3.70	IDEGLIRA_SC_TIT_QD	6.14 1.01 to 29.51
LIXI_SC_20UG_QD	0.28 0.10 to 0.96	0.12 0.04 to 0.49	0.16 0.03 to 0.99	LIXI_SC_20UG_QD

Heterogeneity, fit and convergence

Bayesian random effects (primary)

Heterogeneity (tau): 0.348 (95% CrI 0.078 to 1.448), log scale
Residual deviance: 5.0 for 5 data points
DIC: 9.9 (pD 5.0)
Largest R-hat: 1.001
Smallest ESS: bulk 2,852, tail 2,826
Divergent transitions: 0
Convergence: All criteria met
Priors: PR02 N(0, 5^2); PR05 N(0, 2.5^2); PR09 log normal(-2, 1.58^2) on tau^2 (Biological markers (dichotomised), pharm vs pharm)

Inconsistency

Do trials comparing two treatments directly agree with the indirect evidence through other treatments?

No comparison here has both direct and indirect evidence, so inconsistency cannot be checked by node splitting.

Small study effects

A comparison adjusted funnel plot: each point is one trial comparison, centered on its own network estimate. Asymmetry can signal that small trials with unfavorable results are missing.

Fewer than ten trial comparisons, too few to judge funnel plot asymmetry.

Baseline characteristics of the trials

The baseline value of each effect modifier or prognostic factor that applies here, per trial: mean or percent over arms, weighted by the number randomized. A note under a value names a stand in (a median for a mean, 100 minus the male share, Asian subgroup rows, an all Asian site list); "not reported" means no source of the trial prints it.

Baseline effect modifiers and prognostic factors per trial
Trial	Baseline HbA1c (percent) effect modifier, prognostic factor; 2 of 2	Background glucose lowering therapy (stratum S0 to S4) effect modifier, prognostic factor; 2 of 2	Diabetes duration (years) effect modifier, prognostic factor; 2 of 2
Lixilan-O-AP S000170	8.34	S1	8.55
DUALTM IX S001236	8.3	S1	9.55

Comparability of the trials

Checked across designs (the set of treatments each trial compares) for eligibility, outcome definition and assessment, and the baseline factors above. Flags point to possible intransitivity; notes describe variation that is not tied to design.

FlagOutcome assessment, analysis set: confounded with design: full_analysis 1, modified_itt 1
FlagOutcome assessment, definition: confounded with design: HbA1c below 7 percent at week 24 1, not stated 1
FlagOutcome assessment, intercurrent events (rescue): confounded with design: not stated 1, treatment_policy 1
NoteOutcome assessment, time point: selected time points span 24 to 26 weeks

Comparability items per trial
Trial	time weeks	analysis set	definition	instrument	adjudicated	proportion method	intercurrent events (discontinuation)	intercurrent events (rescue)	blinding	funding	start year	Eligibility
Lixilan-O-AP	24	modified_itt	HbA1c below 7 percent at week 24	not stated	not stated	not stated	treatment_policy	treatment_policy	open_label	industry	2019	adults with T2D on metformin with or without a second OAD; HbA1c 7.5 to 11 percent, or 7 to 10 percent with a non SGLT2i second OAD
DUALTM IX	26	full_analysis	not stated	not stated	not stated	not stated	treatment_policy	not stated	open_label	industry	2016	adults; insulin naive type 2 diabetes on SGLT2 inhibitor with or without other oral drugs; HbA1c 7.0 to 11.0 percent; BMI 20 to 40

Trial data

What each trial contributes. Arm rows give the arm value with its standard error, or events over participants; contrast rows give the odds ratio on the analysis scale (log) against the trial's first row. Flags mark converted, combined or approximated inputs.

Trial data entering this analysis
Trial	Arm	Treatment	Week	Data	Events / N	Source
Lixilan-O-AP	A1	IGLARLIXI2_SC_TIT_QD	24	arm, responders	275 / 348	R0013321:Table 2
Lixilan-O-AP	A2	INS_GLARGINE	24	arm, responders	211 / 349	R0013321:Table 2
Lixilan-O-AP	A3	LIXI_SC_20UG_QD	24	arm, responders	52 / 175	R0013321:Table 2
DUALTM IX	A1	IDEGLIRA_SC_TIT_QD	26	arm, responders	167 / 210	registry:outcomes
DUALTM IX	A2	INS_GLARGINE	26	arm, responders	144 / 210	registry:outcomes

Rerun this analysis yourself

Remove treatments or trials and refit the frequentist and Bayesian models in your browser, with the same methods as the published analysis.

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