title: Effects of three injectable antidiabetic agents on glycaemic control, weight change and drop-out in type 2 diabetes suboptimally controlled with metformin and/or a sulfonylurea: A network meta-analysis.
abstract: OBJECTIVE
  The objective of this review was to assess glucagon-like peptide-1 receptor agonists (GLP-1 RAs), basal insulin, and premixed insulin among participants with type 2 diabetes inadequately controlled with metformin and/or a sulfonylurea.
  
  
  METHODS
  We searched PubMed, EmBase, and the Cochrane Library to identify eligible randomized controlled trials (RCTs) for a network meta-analysis.
  
  
  RESULTS
  A total of 17 RCTs involving 5874 adult individuals were included. Compared with placebo, all three therapies showed a significant effect on achieving target glycated hemoglobin (HbA1c) (GLP-1 RAs: 31.7%, 95% CI, 24.7-38.6%; premixed insulin: 31.1%, 95% CI, 20.4-41.8%; basal insulin: 26.0%, 95% CI, 16.4-35.7%). However, there was no significant difference between the three therapies. A similar result was found in HbA1c reduction. The use of GLP-1 RAs resulted in significant body weight loss (-3.73 kg, 95% CI, -4.52 to -2.95 kg vs. basal insulin and -5.27 kg, 95% CI, -6.17 to -4.36 kg vs. premixed insulin) but there was a higher drop-out rate of participants. Premixed insulin seemed associated with more severe hypoglycemic episodes.
  
  
  CONCLUSIONS
  The three injectables had similar impact on glycemic control but other differentiating features relevant to the management of type 2 diabetes with GLP-1 RAs having the most favorable profile.
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Xihua
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Tianyi
authors.initials: T
authors.lastname: Zhang
authors.affiliation: School of Medicine, Shanghai JIaotong University, Shanghai, China.
authors.forename: Yuzhou
authors.initials: Y
authors.lastname: Liu
authors.affiliation: School of Medicine, Shanghai JIaotong University, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Xinji
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Yingyi
authors.initials: Y
authors.lastname: Qin
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Zhichao
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Xiuqiang
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai 200433, China. Electronic address: hejia63@yeah.net.
authors.forename: Jia
authors.initials: J
authors.lastname: He
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D019058:Community Networks / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D052216:Glucagon-Like Peptide 1 / Q000819:agonists; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D007267:Injections; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds
keywords: Glucagons-like peptide-1 receptor agonist; Injectable antidiabetic agent; Metformin; Network meta-analysis; Sulfonylurea; Type 2 diabetes