Network meta-analysis
HbA1c change
Type 2 diabetes (adults); background therapy: basal insulin with or without non insulin drugs
weeks 36 to 64 (target week 52)Not stated by the trialsDoses of a drug pooledMean difference
2
Randomized trials
3
Treatments
2,126
Participants
4
Trial arms
In plain language
Across 2 trials with 2,126 participants, 0 of 2 treatments had a clearly better result than semaglutide injection on HbA1c change, and for 2 the evidence could not tell them apart from semaglutide injection. The most favorable estimate was for Insulin aspart (prandial): mean difference 0.29 percentage points (95% credible interval -0.71 to 1.19).
Lower 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.
Effects compared with Semaglutide injection
Mean difference in percentage points. Lower values favor the treatment.
| Treatment | Bayesian MD (95% CrI) | 95% prediction interval | Frequentist MD (95% CI) | Verdict |
|---|---|---|---|---|
| Insulin aspart (prandial) INS_ASPART | 0.29 (-0.71 to 1.19) | -1.20 to 1.67 | 0.30 (0.20 to 0.40) | Unclear |
| Insulin glargine INS_GLARGINE | 0.71 (-0.33 to 1.65) | -0.82 to 2.08 | 0.72 (0.57 to 0.87) | Unclear |
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: mean difference of the row treatment versus the column treatment, posterior median and 95% credible interval. Green: row clearly better; red: row clearly worse.
| Row versus column | SEMA_SC | INS_ASPART | INS_GLARGINE |
|---|---|---|---|
| SEMA_SC | SEMA_SC | -0.29 -1.19 to 0.71 | -0.71 -1.65 to 0.33 |
| INS_ASPART | 0.29 -0.71 to 1.19 | INS_ASPART | -0.42 -1.74 to 1.02 |
| INS_GLARGINE | 0.71 -0.33 to 1.65 | 0.42 -1.02 to 1.74 | INS_GLARGINE |
Heterogeneity, fit and convergence
Bayesian random effects (primary)
Frequentist check (netmeta)
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; the between designs Q above is the global check.
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.
| 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 | Asian ancestry or region (percent Asian) effect modifier, prognostic factor; 2 of 2 | Age (years) prognostic factor; 2 of 2 | Treatment duration (weeks) effect modifier; 2 of 2 |
|---|---|---|---|---|---|---|
| SUSTAIN 11 S000363 | 8.55 | S2 | 13.4 | 19.55 | 61.15 | 52 |
| NCT05514535 S001161 | 7.9 | S2 | 12.4 | 9.61 | 61.1 | 40 |
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.
- FlagBaseline, Baseline HbA1c: design means range from 7.9 (INS_GLARGINE vs SEMA_SC) to 8.5 (INS_ASPART vs SEMA_SC) percent; threshold 0.5
- FlagHeterogeneity, tau above threshold: tau 0.33 exceeds the outcome threshold 0.3; the flags of this network are candidate explanations
- NoteOutcome assessment, time point: selected time points span 40 to 52 weeks
| Trial | time weeks | analysis set | definition | instrument | adjudicated | proportion method | intercurrent events (discontinuation) | intercurrent events (rescue) | blinding | funding | start year | Eligibility |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSTAIN 11 | 52 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | open_label | industry | 2018 | adults; HbA1c above 7.5 to 10.0 percent on insulin glargine plus metformin |
| NCT05514535 | 40 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | open_label | industry | 2022 | adults with T2D, BMI 25 or more, HbA1c 7 to 10 percent, basal insulin up to 40 U/day plus metformin with or without SGLT2i |
Trial data
What each trial contributes. Arm rows give the arm value with its standard error, or events over participants; contrast rows give the mean difference on the analysis scale against the trial's first row. Flags mark converted, combined or approximated inputs.
| Trial | Arm | Treatment | Week | Data | Value | SE | Events / N | Flags | Source |
|---|---|---|---|---|---|---|---|---|---|
| SUSTAIN 11 | A1 | SEMA_SC | 52 | arm, change | -1.500 | 0.035 | 795 | registry:outcomes | |
| SUSTAIN 11 | A2 | INS_ASPART | 52 | arm, change | -1.200 | 0.036 | 783 | registry:outcomes | |
| NCT05514535 | A1 | SEMA_SC | 40 | arm, change | -1.370 | 0.051 | 276 | registry:outcomes | |
| NCT05514535 | A2 | INS_GLARGINE | 40 | arm, change | -0.650 | 0.056 | 272 | 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.