Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Newer, non-insulin agents appear to have significant cardiovascular benefits. However, use of these agents for diabetes (DM) management in kidney transplant recipients (KTR) has not been well characterized. The purpose of this study is to: 1) characterize the use of non-insulin agents in KTRs; 2) compare the use of non-insulin agents in KTRs to guideline recommendations for non-KTRs; and 3) to characterize the occurrence of adverse events of interest for non-insulin agents in KTRs.
*Methods: Diabetes management in HIV negative adult KTRs diagnosed with post-transplant DM and transplanted at our center from 01/01/16-06/30/17 were retrospectively reviewed. Multiorgan transplant recipients and DM1 KTRs were excluded. Demographics and post-transplant data, including HbA1c and serum creatinine, were followed for 3 to 24 months post-transplant.
*Results: Eighty-three KTRs met inclusion criteria. See Table 1 for demographics. Non-insulin agent use was ~60% from 6 to 24 months post-transplant. Renal function remained stable throughout the study period. Metformin was the most common non-insulin agent prescribed (41%), but an estimated 66% of “metformin eligible” KTRs (eGFR >30 mL/min) did not receive this ADA first-line agent (Figure 1). Over the study period, there was a mean (SD) change in BMI of +1.9 kg/m2 (2.6). In those KTRs with an increase in BMI, 30% of non-insulin agents prescribed were a sulfonylurea or meglitinide vs. only 15% a GLP-1 agonist. No SGLT2 inhibitors were prescribed in the study cohort. No KTRs were observed to develop thyroid malignancy or pancreatitis following initiation of incretin therapy.
*Conclusions: 1) Use of first line (per ADA) non-insulin agents for management of DM remains low in the KTR population. 2) No key adverse effects were reported, suggesting that non-insulin agents may have an acceptable safety profile. 3) Further study is needed to describe the improvement to BMI, safety, and cardiovascular benefit of GLP-1 agonists, DPP-4 inhibitors, and SGLT-2 inhibitors in KTRs.
|Median Age at Transplant, yrs (IQR)||60 (51-64)|
|Race, n (%)||–|
|White Caucasian||32 (38.6)|
|Type 2 Diabetes Present at Transplant, n (%)||58 (69.9)|
|Mean HbA1c at 24 months, % (SD)||7.5 (1.5)|
To cite this abstract in AMA style:Norris M, Trofe-Clark J, Sammons C, Casciello N, Cardillo S, Sawinski D, Bloom RD, Malat G. Characterization of Use and Safety of Non-Insulin Agents for Management of Post-Transplant Diabetes Mellitus in the Kidney Transplant Population [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/characterization-of-use-and-safety-of-non-insulin-agents-for-management-of-post-transplant-diabetes-mellitus-in-the-kidney-transplant-population/. Accessed October 25, 2020.
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