TY - JOUR
T1 - A Retrospective Study of Glucagon-Like Peptide 1 Receptor Agonists for the Management of Diabetes After Transplantation
AU - Thangavelu, Thiyagarajan
AU - Lyden, Elizabeth
AU - Shivaswamy, Vijay
N1 - Funding Information:
We thank Dr. Clifford Miles, Dr. Timothy McCashland, Dr. Adam Burdorf, and Dr. Brian Boerner for their invaluable help in identifying the subjects for the study. No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Thiyagarajan Thangavelu, Elizabeth Lyden, and Vijay Shivaswamy have nothing to disclose. The study was approved by UNMC Institutional Review Board (IRB) protocol # 806-18-EP. Exemption to consent was approved by the IRB, since there was no or minimal risk to subjects because of the retrospective nature of the study. The study conformed with the Helsinki declaration of 1964, as revised in 2013, concerning human and animal rights. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Introduction: Management of post-transplant diabetes mellitus is challenging; there is a lack of prospective randomized controlled trials for safety and efficacy of antidiabetic medications in solid organ recipients. Glucagon-like peptide 1 receptor agonists (GLP-1RA) are a relatively new class of medications used to manage type 2 diabetes in the general population. They have several benefits besides glycemic control, including weight loss and improved cardiovascular risk. However, they have not been studied extensively in the post-transplant population for safety and efficacy. Methods: We conducted a retrospective study of patients who had received kidney, liver, or heart transplant, had diabetes either pre- or post-transplant, and were treated with GLP-1RA. We identified seven kidney, seven liver, and five heart transplant recipients who had received GLP-1RA. We assessed changes in immunosuppressant levels, rejection episodes, changes in hemoglobin A1c (HbA1c), weight, and body mass index (BMI) while on the GLP-1RA. We also looked at changes in insulin dose, other diabetes medications, heart rate, blood pressure, and renal function. Results: After a mean follow-up period of 12 months, there were no significant changes in tacrolimus (FK506) levels and renal function for the period of GLP-1RA use. At the end of 12 months, the mean drop in weight was 4.86 kg [95% CI − 7.79, − 1.93]. The BMI decreased by a mean of 1.63 kg/m2 at the end of 12 months [95% CI − 2.53, − 0.73]. HbA1c decreased from baseline by 1.08% [95% CI − 1.65, − 0.51], 0.96% [95% CI − 1.68, − 0.25], and 0.75% [95% CI − 1.55, 0.05] at 3, 6, and 12 months, respectively. Conclusions: Our data suggest that GLP-1RA do not affect tacrolimus levels or transplant outcomes in solid organ transplant (SOT) recipients in the short term. GLP-1RA also seem to be as effective in SOT recipients for glycemic control and weight loss as in the non-transplant population with diabetes.
AB - Introduction: Management of post-transplant diabetes mellitus is challenging; there is a lack of prospective randomized controlled trials for safety and efficacy of antidiabetic medications in solid organ recipients. Glucagon-like peptide 1 receptor agonists (GLP-1RA) are a relatively new class of medications used to manage type 2 diabetes in the general population. They have several benefits besides glycemic control, including weight loss and improved cardiovascular risk. However, they have not been studied extensively in the post-transplant population for safety and efficacy. Methods: We conducted a retrospective study of patients who had received kidney, liver, or heart transplant, had diabetes either pre- or post-transplant, and were treated with GLP-1RA. We identified seven kidney, seven liver, and five heart transplant recipients who had received GLP-1RA. We assessed changes in immunosuppressant levels, rejection episodes, changes in hemoglobin A1c (HbA1c), weight, and body mass index (BMI) while on the GLP-1RA. We also looked at changes in insulin dose, other diabetes medications, heart rate, blood pressure, and renal function. Results: After a mean follow-up period of 12 months, there were no significant changes in tacrolimus (FK506) levels and renal function for the period of GLP-1RA use. At the end of 12 months, the mean drop in weight was 4.86 kg [95% CI − 7.79, − 1.93]. The BMI decreased by a mean of 1.63 kg/m2 at the end of 12 months [95% CI − 2.53, − 0.73]. HbA1c decreased from baseline by 1.08% [95% CI − 1.65, − 0.51], 0.96% [95% CI − 1.68, − 0.25], and 0.75% [95% CI − 1.55, 0.05] at 3, 6, and 12 months, respectively. Conclusions: Our data suggest that GLP-1RA do not affect tacrolimus levels or transplant outcomes in solid organ transplant (SOT) recipients in the short term. GLP-1RA also seem to be as effective in SOT recipients for glycemic control and weight loss as in the non-transplant population with diabetes.
KW - GLP-1RA
KW - Glucose
KW - Immunosuppressants
KW - Transplant
KW - Type 2 diabetes
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U2 - 10.1007/s13300-020-00786-1
DO - 10.1007/s13300-020-00786-1
M3 - Article
C2 - 32072430
AN - SCOPUS:85079709504
SN - 1869-6953
VL - 11
SP - 987
EP - 994
JO - Diabetes Therapy
JF - Diabetes Therapy
IS - 4
ER -