A large review of studies looked at three combination diabetes drugs and their individual parts to see which works best for people with type 2 diabetes. The combinations studied were insulin degludec with liraglutide (IDegLira), insulin glargine with lixisenatide (iGlarLixi), and insulin degludec with insulin aspart (IDegAsp). The review included 12,815 patients and compared these combos to using the individual drugs alone.
The main goal was to see how well each treatment lowered blood sugar levels (HbA1c and fasting glucose) and how often they caused low blood sugar (hypoglycemia). The results showed that IDegLira had the highest chance of being the best at lowering HbA1c and fasting glucose. It also had the highest chance of causing fewer low blood sugar events. However, IDegLira and iGlarLixi caused more side effects overall compared to IDegAsp.
Side effects, called treatment-emergent adverse events (TEAEs), were more common with IDegLira and iGlarLixi. The odds of having a side effect were about 1.7 times higher for these two combos compared to IDegAsp. On the other hand, IDegAsp had the best safety profile, with the lowest chance of causing side effects.
The review used a method called network meta-analysis to compare all treatments at once. It calculated SUCRA scores, which show the probability that a treatment is the best for a certain outcome. For lowering blood sugar, IDegLira had a SUCRA of 89.4% for HbA1c and 81.8% for fasting glucose. For preventing low blood sugar, it had a SUCRA of 57.6%. For avoiding side effects, IDegAsp had a SUCRA of 97.9%.
It is important to note that these SUCRA scores are rankings of probability, not proof that one treatment is definitely better than another. Also, the results for low blood sugar were not consistent across studies, possibly because different definitions were used. So, the findings should be interpreted with caution.
In summary, IDegLira appears to be a strong option for improving blood sugar control with a lower risk of low blood sugar, but it may cause more side effects. IDegAsp may be better for patients who are concerned about side effects. Patients should discuss these options with their doctor to find the best treatment for their individual needs.