Abstract #1406346: Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonist (GLP-1-RA) in Patients with Diabetes who Underwent Kidney Transplantation (KT): A Retrospective Study with a Control Group

Abstract

Glucose like peptide-1 receptor agonist (GLP1-RA) have been shown to reduce cardiovascular mortality and promote weight loss in general population. Uncontrolled diabetes after solid-organ transplantation has been associated to weight gain, high cardiovascular mortality and transplant rejection. Despite the metabolic benefits of GLP1RA, their efficacy and safety in the post-transplant period are yet to be established. Tolerability of GLP1RA during the first months after KT have been questioned due to possible gastrointestinal side effects. We aim to describe the efficacy and safety in controlling diabetes and weight, comparing kidney-transplanted participants with diabetes who initiated GLP1RA to participants who did not. Adults (n=50) with diabetes who underwent KT from 08/2020 to 08/2022 at UAB-Transplant Institute were included. 25 participants on insulin ± oral antidiabetic medications initiated GLP1RA (cases) and 25 participants on insulin ± oral antidiabetic did not start GLP1RA (controls). GLP1RA was started 7.72 months ±5.26 after KT and 88% of them started using GLP1RA for the first time. Participants who started GLP1RA did not report active gastrointestinal symptoms and were educated to eat small-meal portions. Metabolic outcomes evaluated were HbA1C, fructosamine, weight, total daily insulin dose (TDD), and Continuous Glucose Monitoring parameters. The outcomes were evaluated before starting GLP1RA and 6 months after. Due to the longitudinal nature of the study, linear mixed models were developed to test for changes over time. KT participants (case, control) were predominantly of age (56.28 years, 57.40 years (p=0.6)), male (64%, 64% (p=1.0)), African American (60%, 84% (p=0.23)) and had type 2 diabetes (56%, 68% (p=0.1)). There was a statistically significant reduction in weight and total daily insulin dose between the two groups 1) Weight: Cases (at baseline, 206.04±38.09 pounds; at 6 months after starting GLP1RA, 204.17±40.08 pounds). Controls (at baseline, 180.96±45.49 pounds; at 6 months 188.61±43.69 pound) (p=0.001); 2) TDD: Cases (at baseline, 61.28±42.18 units, at 6 months, 56.13 ±40.95 units), Controls (at baseline, 34.03±22.49 units; at 6 months, 41.65±25.58 units) (p=0.001). There was no statistical significance between cases and controls for A1C (p=0.70), fructosamine (p=0.91), Glucose Management Indicator (p=0.91), Time In-Range (p=0.51), Time Below-Rage (p=0.91), blood tacrolimus levels (p=0.91). P-values for the test of interaction between covariate (race, GLP1RA type and insulin type) and time for the outcome were not significant. None of the participants developed significant gastrointestinal side effects and the rate of GLP1RA discontinuation was 0%. GLP1RA are safe and effective in reducing insulin requirements and promoting weight loss in the early KT period. No changes in blood tacrolimus levels were found. There were no differences in glucose control parameters in participants who used GLP1RA compared to other antidiabetic therapies that include insulin. Choosing the ideal patient and offering education prior starting GLP1RA is recommended.