Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation

Abstract

Uncontrolled type 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM) increase morbidity and mortality after kidney transplantation. Conventional strategies for diabetes management in this population include metformin, sulfonylureas, meglitinides and insulin. Limitations with these agents, as well as promising new antihyperglycemic agents, create a need and opportunity to explore additional options for transplant diabetes pharmacotherapy. Novel agents including sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1RA), and dipeptidyl peptidase IV inhibitors (DPP4i) demonstrate great promise for T2DM management in the non-transplant population. Moreover, many of these agents possess renoprotective, cardiovascular, and/or weight loss benefits in addition to improved glucose control while having reduced risk of hypoglycemia compared with certain other conventional agents. This comprehensive review examines available literature evaluating the use of novel antihyperglycemic agents in kidney transplant recipients (KTR) with T2DM or PTDM. Formal grading of recommendations assessment, development, and evaluation (GRADE) system recommendations are provided to guide incorporation of these agents into post-transplant care. Available literature was evaluated to address the clinical questions of which agents provide greatest shortand long-term benefits, timing of novel antihyperglycemic therapy initiation after transplant, monitoring parameters for these antihyperglycemic agents, and concomitant antihyperglycemic agent and immunosuppression regimen management. Current experience with novel antihyperglycemic agents is primarily limited to single-center retrospective studies and case series. With ongoing use and increasing comfort, further and more robust research promises greater understanding of the role of these agents and place in therapy for kidney transplant recipients.

Safety and efficacy of semaglutide in post kidney transplant patients with type 2 diabetes or Post-Transplant diabetes

“…In this study, 46 % of the patients had PTDM/NODAT, which means that they were diagnosed with diabetes after transplantation. This finding is consistent with other studies that reported that 30–50 % of patients with renal transplants develop PTDM [19] , [20] , [21] . The high PTDM prevalence is linked to classic T2DM risk factors, such as older age and obesity, which are common among renal transplant recipients.…”

Adverse Drug Events after Kidney Transplantation

“…Novel agents, including sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1RA), and dipeptidyl peptidase IV inhibitors (DPP4i), show great promise for type 2 diabetes management in the non-transplant population. However, current experience with novel antihyperglycemic agents is primarily limited to single-center retrospective studies and case series [36].…”

Novel Drugs for the Management of Diabetes Kidney Transplant Patients: A Literature Review

“…Based on these premises, the use of available drugs will be personalized for each patient in order to achieve the maximum benefit attributed to each drug while minimizing the associated adverse effects. In the case of the use of SGLT2i, it is recommended that concomitant treatment be modified, and that monitoring measures are implemented to optimize patient status and minimize potential adverse effects Adapted of [ 22 , 112 , 113 ].…”