Objective: Despite intensive insulin treatment in patients with type 1 diabetes (T1D), their glycemic levels often do not reach the recommended target goal. We performed a network meta-analysis to evaluate the efficacy and safety of additional therapy to insulin in patients with T1D.
Methods: We searched CENTRAL, MEDLINE, and Embase from 1970 until January 2019 to identify randomized controlled trials (RCTs) in T1D patients treated with insulin and oral hypoglycemic agents or glucagon-like peptide-1 receptor agonists. We performed network meta-analyses using Bayesian models and generated rankings of the different hypoglycemic agents by generation mixed treatment comparison.
Results: With 23 RCTs (n =3,839), we performed the network meta-analysis using eight groups; 1) insulin alone, 2) insulin and metformin, 3) insulin and canagliflozin, 4) insulin and dapagliflozin, 5) insulin and empagliflozin, 6) insulin and sotagliflozin, 7) insulin and liraglutide, and 8) insulin and exenatide. Compared with insulin alone, HbA1c was significantly lower in the group treated with insulin and sotagliflozin (mean difference: -0.43%; 95% Crl: -0.66, -0.20). Total daily insulin dose was significantly lower in the insulin and sotagliflozin group by 6.4 U/day than other groups. Compared with insulin alone, body weight was decreased in the group with insulin and canagliflozin by 4.5 kg, insulin and sotagliflozin by 2.8 kg, insulin and liraglutide by 4.5kg, and insulin and exenatide by 5.1 kg, respectively. Severe hypoglycemic episodes did not differ between the groups.
Conclusions: In patients with T1D, sotagliflozin treatment combined with insulin decreased HbA1c levels, insulin dose, and body weight without hypoglycemia compared with insulin monotherapy. Combined treatment of canagliflozin, liraglutide, or exenatide with insulin was also effective in weight loss compared with insulin alone in these patients.
Y. Kim: None. S. Hwang: None. S. Lim: None.
