# Diabetes Mellitus in Kidney Transplant Recipients and New Hypoglycemic Agent Options

## TL;DR

This review explores new diabetes treatments for kidney transplant patients, focusing on their safety and potential to reduce heart disease and transplant rejection risks.

## Contribution

The paper provides an updated review of novel hypoglycemic agents for kidney transplant recipients with diabetes.

## Key findings

- SGLT2is and GLP1RAs appear safe and effective in kidney transplant recipients.
- These drugs may counteract immunosuppressive therapy's negative metabolic effects.
- Finerenone's use in this population remains understudied with only one ongoing trial.

## Abstract

Diabetes mellitus (DM) is frequent in kidney transplant recipients (KTRs), reducing graft and patient survival. In recent years, hypoglycemic agents have been approved for chronic kidney disease (CKD) patients, such as sodium glucose co-transporter type 2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP1RAs), and nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs), such as finerenone. Several studies demonstrated the ability of these drugs to reduce cardiovascular (CV) events and kidney disease progression in diabetic CKD patients. In this review, we will describe their use in KTRs with type 2 DM or post-transplant diabetes mellitus (PTDM), focusing on the potential positive effects. In particular, we will report literature data from observational studies, meta-analyses, and clinical trials. Based on their mechanism of actions, these drugs may balance the negative effects of immunosuppressive therapy on metabolic balance, reducing the risk of PTDM and CV events, that remain the first cause of death in KTRs. Generally, SGLT2is and GLP1RAs appear to be safe and efficacious in KTRs, and no interaction with immunosuppressive drugs or an increased risk of rejection has been reported. Regarding finerenone, no literature data are available and only one clinical trial is ongoing. In conclusion, although the 2022 KDIGO guidelines recommend caution in KTRs, the last meeting in Vienna on PTDM encourages their use in this population.