SUN-165 The Largest Single-Center Experience of GLP-1 Receptor Agonists as a Safe and Effective Agent for the Management of Diabetes in Solid Organ Transplant (SOT) Recipients

Abstract

Background Post-transplant diabetes mellitus is a well-recognized complication of SOT. There is a limited published data regarding the approach to management. We aim to test the efficacy and safety of a GLP-1 analog, dulaglutide, an incretin-based therapy in this population. Methods We performed a retrospective, chart review of adult SOT recipients (> 18 years) with diabetes and on dulaglutide. We identified 63 recipients and collected data at 6, 12 and 24 months post GLP1 therapy. The primary endpoint was: change in weight, BMI, and insulin requirement. Safety endpoint included hypoglycemia, GI side-effects, and cancers. Secondary endpoints were: HbA1c, renal and liver function. Results There was a sustained, statistically significant reduction in weight, BMI, and insulin requirement with Dulaglutide at each study period. The mean of paired difference for weight reduction was 2.07 (p-value < 0.003), 4.007 (p-value < 0.001), and 5.23 kgs (p-value <0.034) at 6, 12 and 24 months respectively. BMI followed a similar trend with 0.80 (p-value < 0.001), 1.35 (p-value < 0.005) and 2.015 Kg/m2 reduction (p-value <0.045) at 6, 12 and 24 months respectively. Encouragingly, the mean paired difference for insulin reduction pre, and post-GLP-1 was 5.94 units (p-value < 0.0002). 47% of recipients had a decreased insulin requirement, and 13% were able to stop all other diabetic medications. There was a trend of decrease of HbA1c throughout the follow-up, but it was statistically significant only in the first six months (mean of paired difference at six months 0.7509, p-value < 0.001). It’s likely because the A1C target was maintained with GLP1 analog while reducing the anti-diabetic therapy. Less than 3% of patient had nonsevere hypoglycemia or GI manifestations, none requiring discontinuation of medications. There was one graft failure, one anginal episode, and two mortality (one from sepsis and another was an unknown cause) throughout the follow-up. There was no increased incidence of pancreatitis, transaminitis or cancer. The eGFR was stable throughout the study including in patients with advanced kidney disease. Immunosuppressive agents remained unchanged. Conclusions Our large single-center study in SOT recipients not only demonstrated the sustained beneficial effects of GLP1 in the reduction of weight, BMI, insulin, and other hypoglycemic agents but also exhibited a favorable side-effect profile (minimal GI side-effects) without any significant organ damage (stable cardiovascular, renal, and liver function) or interference with immunosuppressant. Further prospective randomized trials in transplant patients are warranted.