New-Onset Diabetes in Patients Post-Heart Transplantation; the Role of Hypertension and Novel Diabetic Medications

Abstract

<h3>Purpose</h3> New-onset post-transplantation diabetes mellitus (DM) is common among heart transplant (HT) recipients and has been shown to be associated with higher rates of renal dysfunction and death or re-transplantation. There are limited data to describe the use of novel anti-diabetic therapies in this population. We aimed to describe the prevalence of newly diagnosed DM and DM treatment patterns in HT patients at a single high-volume transplant center<b>.</b> <h3>Methods</h3> Patients undergoing HT between 1/2010-12/2017 were retrospectively reviewed. Patients undergoing repeat HT were excluded from the analysis. New-onset DM was defined by HbA1c >= 6.5% or initiation of anti-diabetic therapy. Data were collected from the electronic medical record. <h3>Results</h3> 280 transplant patients were identified with a median follow-up of 5.1 (IQR 2.6-8.1) years. 95 (33.9%) had pre-transplant DM. Of the 185 remaining patients, 45 (24.3%) developed post-HT DM with a median time to diagnosis of 109 (IQR 20-439) days. Median age of those with new-onset DM was 54 (IQR 47-61) years and 37.8% were female. Risk of PTDM was 18.2% at 1 year, 20.0% at 2 years, 23.8% at 5 years, and 33.1% at 10 years (<b>Fig 1a</b>). Hypertension was independently associated with post-HT DM (p = 0.014, <b>Fig 1b</b>). Among all patients with DM in the post-transplant period (N=140), 10 (7.1%) were started on a sodium-glucose cotransporter-2 inhibitor (SGLT2i) and 17 (12.1%) were treated with a glucagon-like peptide-1 receptor agonist (GLP-1 RA). Adverse events with SGLT2i included polyuria in 2 patients, and adverse events with GLP-1 RA included gastrointestinal disturbance in 2 patients, palpitations in 1 patient, and discontinuation for unknown reasons in 1 patient. <h3>Conclusion</h3> DM is a common co-morbidity among HT recipients, with a high rate of pre-existing DM and post-HT DM. Utilization of the newest anti-diabetic agents with known cardiovascular benefits remains low in this cohort.