Network meta-analysis
Weight loss of 5 percent or more
Type 2 diabetes (adults); background therapy: basal insulin with or without non insulin drugs
weeks 20 to 40 (target week 26)Hypothetical (as if everyone stayed on treatment)Each dose separatelyOdds ratio
2
Randomized trials
3
Treatments
898
Participants
50
Events
In plain language
Across 2 trials with 898 participants, 0 of 2 treatments had a clearly better result than placebo on weight loss of 5 percent or more, and for 2 the evidence could not tell them apart from placebo. The most favorable estimate was for Exenatide extended release 2 mg subcutaneous once weekly: odds ratio 3.11 (95% credible interval 0.84 to 10.95).
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.
Effects compared with Placebo
Odds ratio. Higher values favor the treatment.
| Treatment | Bayesian OR (95% CrI) | 95% prediction interval | Frequentist OR (95% CI) | Verdict |
|---|---|---|---|---|
| Exenatide extended release 2 mg subcutaneous once weekly EXENER_SC_2MG_QW | 3.11 (0.84 to 10.95) | 0.54 to 16.37 | 3.22 (1.41 to 7.32) | Unclear |
| Lixisenatide 20 ug subcutaneous once daily LIXI_SC_20UG_QD | 1.57 (0.40 to 6.29) | 0.27 to 8.48 | 1.62 (0.62 to 4.27) | 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: odds ratio 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 | PLACEBO | EXENER_SC_2MG_QW | LIXI_SC_20UG_QD |
|---|---|---|---|
| PLACEBO | PLACEBO | 0.32 0.09 to 1.19 | 0.64 0.16 to 2.48 |
| EXENER_SC_2MG_QW | 3.11 0.84 to 10.95 | EXENER_SC_2MG_QW | 1.96 0.30 to 12.39 |
| LIXI_SC_20UG_QD | 1.57 0.40 to 6.29 | 0.51 0.08 to 3.29 | LIXI_SC_20UG_QD |
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 BMI or body weight (kg/m2) effect modifier, prognostic factor; 2 of 2 | Sex (percent female) effect modifier, prognostic factor; 2 of 2 | Treatment duration (weeks) effect modifier; 2 of 2 | Lifestyle co-intervention intensity (none standard intensive) effect modifier, prognostic factor; 2 of 2 |
|---|---|---|---|---|
| NCT02229383 S000703 | 33.7 | 52.04 100 minus male share | 28 | standard |
| GetGoal-Duo1 S000792 | 31.85 | 50.22 | 24 | not_reported |
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, Lifestyle co-intervention intensity: each design has a different category: EXENER_SC_2MG_QW vs PLACEBO = standard; LIXI_SC_20UG_QD vs PLACEBO = not_reported
- FlagOutcome assessment, proportion method: confounded with design: not stated 1, not_stated 1
- NoteOutcome assessment, time point: selected time points span 24 to 28 weeks
- NoteData handling, input conversions: count_from_percent 2
| Trial | time weeks | analysis set | definition | instrument | adjudicated | proportion method | intercurrent events (discontinuation) | intercurrent events (rescue) | blinding | funding | start year | Eligibility |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NCT02229383 | 28 | modified_itt | not stated | not stated | not stated | not stated | hypothetical | hypothetical | double_blind | industry | 2014 | adults; insulin glargine 20 U/d or more with or without metformin; HbA1c 7.0 to 10.5 percent at randomization |
| GetGoal-Duo1 | 24 | modified_itt | not stated | not stated | not stated | not_stated | hypothetical | hypothetical | double_blind | industry | 2009 | T2D on metformin 1.5 g or more with or without SU, glinide or TZD, HbA1c 7 to 10, BMI over 20; HbA1c 7 to 9 after run in |
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 | Arm | Treatment | Week | Data | Value | SE | Events / N | Flags | Source |
|---|---|---|---|---|---|---|---|---|---|
| NCT02229383 | A1 | EXENER_SC_2MG_QW | 28 | arm, responders | 24 / 231 | R0014763:Table 2 | |||
| NCT02229383 | A2 | PLACEBO | 28 | arm, responders | 8 / 230 | R0014763:Table 2 | |||
| GetGoal-Duo1 | A1 | PLACEBO | 24 | arm, responders | 7 / 220 | count_from_percent | registry:outcomes | ||
| GetGoal-Duo1 | A2 | LIXI_SC_20UG_QD | 24 | arm, responders | 11 / 217 | count_from_percent | 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.