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Aims  Since 2005, several glucagon‐like peptide‐1 receptor agonists ( GLP ‐1  RAs ) have been approved to treat people with type 2 diabetes. These agents are considered for use at the same point in the treatment paradigm as basal insulins. A comprehensive comparison of these drug classes, therefore, can help inform treatment decisions. This systematic review and meta‐analysis assessed the clinical efficacy and safety of  GLP ‐1  RAs  compared with basal insulins.    Materials and methods   MEDLINE ,  EMBASE ,  CENTRAL  and  PubMed  databases were searched. Randomized clinical trials ( RCTs ) of ≥16 weeks’ duration comparing  GLP ‐1  RAs  vs basal insulins in adults with type 2 diabetes inadequately controlled with oral antihyperglycemic drugs were included. Data on the change from baseline to 26 weeks (±10 weeks) of treatment in hemoglobin A1c ( HbA1c ) and weight, as well as the proportion of patients experiencing hypoglycaemia, were extracted. Fixed‐effect pairwise meta‐analyses were conducted where data were available from ≥2 studies.    Results  Fifteen  RCTs  were identified and 11 were meta‐analysed. The once‐weekly  GLP ‐1  RAs , exenatide long acting release ( LAR ) and dulaglutide, led to greater, statistically significant mean  HbA1c  reductions vs basal insulins (exenatide: −0.31% [95% confidence interval −0.42, −0.19], dulaglutide: −0.39% [−0.49, −0.29]) whilst once‐daily liraglutide and twice‐daily exenatide did not (liraglutide: 0.06% [−0.06, 0.18], exenatide: 0.01% [−0.11, 0.13]). Mean weight reduction was seen with all  GLP ‐1  RAs  while mean weight gain was seen with basal insulins. Interpretation of the analysis of hypoglycaemia was limited by inconsistent definitions and reporting. Because of the limited number of available studies sensitivity analyses to explore heterogeneity could not be conducted.    Conclusions  Although weight reduction is seen with all  GLP‐1 RA ’s, only the once‐weekly agents, exenatide  LAR  and dulaglutide, demonstrate significant  HbA1c  reductions when compared to basal insulins.

diabetes, obesity and metabolism

Glucagon‐like peptide‐1 receptor agonists compared with basal insulins for the treatment of type 2 diabetes mellitus:  a  systematic review and meta‐analysis