Effects of insulin regimens for type 2 diabetes mellitus: a systematic review and network meta-analysis
Authors' conclusion
Complex insulin regimens provide modest glycaemic benefits over basal insulin but are associated with greater weight gain and a suggested higher risk of hypoglycaemia. These results are based on evidence of moderate confidence. These trade-offs support the need for individualised regimen selection, informed by clinical context, patient preferences and treatment goals.
Study context
- Population
- Adults with T2D in RCTs comparing ≥2 insulin regimens over ≥12 weeks
- Participants
- 19,122 adults58 RCTs
- Comparison
- Basal-bolus, biphasic and prandial insulin vs basal insulin
- Outcome
- HbA1c reduction
Methodological detailsfrequentist random-effects model, basal insulin as reference, Risk of bias assessed with Cochrane RoB-2, Searched PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov through September 2025
- Frequentist random-effects model
- Basal insulin as reference
- Risk of bias assessed with Cochrane RoB-2
- Searched PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov through September 2025
Pooled result
As reported in the abstract
Each group vs basalDifference, mmol/mol (95% CI)
Basal-bolus−0.31% [95% CI −0.45%, −0.17%]
−3.4(−4.9 to −1.9)
Biphasic−0.24% [95% CI −0.34%, −0.15%]
−2.7(−3.7 to −1.6)
Prandial−0.38% [95% CI −0.57%, −0.19%]
−4.1(−6.2 to −2.1)
Further pooled results
HbA1c target, weight
- All regimens: ≈30% increased probability of achieving HbA1c target vs basal
- All regimens: ≈1 kg greater weight gain vs basal
Insulin dose
- Insulin doses slightly higher with basal-bolus and biphasic regimens
Quality of life
- Quality-of-life data were limited
Subgroups: insulin initiation and intensification
- Consistent results
Safety
- All regimens: borderline increase in risk of severe hypoglycaemia vs basal
Original publication
Effects of insulin regimens for type 2 diabetes mellitus: a systematic review and network meta-analysis. Diabetologia. Published 24 December 2025. doi:10.
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