# GLP-1 Receptor Agonists and SGLT2 Inhibitors in Stable Kidney Transplantation: Clinical Outcomes from a Cohort of Patients with Post-Transplant Diabetes Mellitus

## TL;DR

This study examines how GLP-1 receptor agonists and SGLT2 inhibitors affect kidney transplant patients with diabetes, finding benefits in weight and lipid metabolism without harming kidney function.

## Contribution

The study provides new clinical evidence on the safety and metabolic benefits of GLP-1 RAs and SGLT2 inhibitors in kidney transplant recipients with diabetes.

## Key findings

- Treatment led to significant weight loss and improved lipid profiles in patients.
- Kidney function remained stable with no major adverse events observed.
- GLP-1 RAs and SGLT2 inhibitors showed a favorable safety profile in this patient group.

## Abstract

Background: Despite the lack of formal indication for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter-2 inhibitors (SGLT2i) in post-transplant diabetes mellitus (PTDM), their use in clinical practice is growing. While robust evidence supporting their use in kidney transplant recipients (KTRs) remains limited, PTDM remains a major driver of adverse outcomes, including cardiovascular morbidity, accelerated graft dysfunction, graft loss, and reduced survival. Methods: This retrospective cohort study analyzed adult KTRs with PTDM treated with SGLT2is and/or GLP-1 RAs between 2013 and 2024. Metabolic, kidney, and safety parameters were assessed from baseline to follow-up. Results: After a median treatment duration of 1.8 years, glycated hemoglobin (HbA1c) changed from 7.22% to 7.01% (p = 0.558), whereas fasting plasma glucose increased from 112.62 mg/dL to 125.01 mg/dL (p = 0.03). Body mass index decreased from 27.27 kg/m2 to 25.95 kg/m2 (p < 0.001). The lipid profile improved, with reductions in total cholesterol (p < 0.01) and low-density lipoprotein cholesterol (LDL-c, p = 0.02). Kidney function remained stable throughout the observation period, and adverse events were infrequent. Conclusions: In KTRs with PTDM, GLP-1 RAs and SGLT2is were associated with significant improvements in weight and lipid metabolism, alongside stable kidney function and a favorable safety profile. These findings support the consideration of these agents in the management of PTDM. Prospective studies are warranted to confirm these results.