GLP-1s lower BMI, preserve kidney function for adults with diabetes post-kidney transplant
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Key takeaways:
- Adults with diabetes who underwent kidney transplantation had greater reductions in BMI and body weight if they used a GLP-1.
- No significant gastrointestinal adverse events were reported with GLP-1 use.
SEATTLE — Adults with diabetes who used a GLP-1 receptor agonist after undergoing kidney transplantation had a decline in BMI and more stable measures of kidney function than those who did not use a GLP-1, according to a speaker.
In findings from a small study presented at the AACE Annual Scientific and Clinical Conference, researchers compared data from 25 adults who underwent kidney transplantation and took a GLP-1 receptor agonist after the procedure with a group of adults who did not use a GLP-1 after transplantation. In addition to having a greater reduction in BMI and total daily insulin use, the GLP-1 group had better preservation of glomerular filtration rate and creatinine levels at 3- and 6-month follow-ups than the group that did not receive a GLP-1.
“Adding a GLP-1 receptor agonist as a coadjutant therapy in the early post-transplant period to the appropriate patient brings good metabolic outcomes and also is safe,” Mario Campana, MD, fellow in the division of endocrinology, diabetes and metabolism at the Heersink School of Medicine at the University of Alabama at Birmingham (UAB), told Healio.
Researchers enrolled 50 adults aged 18 years and older with type 2 diabetes who underwent kidney transplantation at the UAB Comprehensive Transplant Institute from August 2020 to August 2022. The cohort was divided into one group of 25 adults who initiated GLP-1 receptor agonist therapy after the transplantation and a control group of 25 adults who did not use a GLP-1. Adults in both groups used insulin and oral diabetes medications during the study. HbA1c, fructosamine, weight, BMI, total daily insulin dose and continuous glucose monitoring measures were analyzed at baseline before GLP-1 therapy began and 3 and 6 months after GLP-1 initiation. Safety outcomes included tacrolimus levels, creatinine and GFR.
Adults in the GLP-1 group began GLP-1 use a mean 7.72 months after their kidney transplantation. Of the group, 88% were using a GLP-1 receptor agonist for the first time.
BMI in the GLP-1 group decreased from 31.77 kg/m2 at baseline to 31.14 kg/m2 at 6 months, whereas the control group had a BMI increase from 27.69 kg/m2 at baseline to 28.41 kg/m2 at 6 months (P < .01). The GLP-1 group had a decline in total daily insulin use from 61.28 U at baseline to 56.13 U at 6 months. The control group had an increase in total daily insulin from 34.03 U at baseline to 41.65 U at follow-up (P < .01). Changes in HbA1c, fructosamine and CGM metrics were similar between the two groups.
Adults using a GLP-1 had an increase in GFR from 50.48 mL/min/1.73 m2 at baseline to 53.44 mL/min/1.73 m2 at 6 months, whereas the control group had a decrease from 43.4 mL/min/1.73 m2 at baseline to 40.84 mL/min/1.73 m2 at 6 months (P = .03). Creatinine levels remained relatively stable in the GLP-1 while increasing from 2.2 mg/dL at baseline to 2.74 mg/dL at 6 months for adults not using a GLP-1.
No one in the GLP-1 group experienced significant gastrointestinal adverse events during the study, and none discontinued GLP-1 use.
Campana said the study has a small number of participants and was retrospective in nature.
“The next step is prospective studies and clinical trials comparing patients with pretransplant diabetes on GLP-1 receptor agonists or dual agents to patients just on insulin or with any other oral medications,” Campana said.
Perspective
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This is a nice pilot study looking at giving a GLP-1 receptor agonist to kidney transplant patients. Many internal medicine physicians and endocrinologists see patients after a kidney transplant. Most of us have concerns about giving any medication to a transplant patient.
Potentially, GLP-1 receptor agonists may be useful in this setting although very little data is available. The most obvious reasons for GLP-1 use in this setting is the weight management and blood sugar control. The other more important reason in this particular setting is that GLP-1 receptor agonists do not require a functioning kidney to be metabolized and broken down. They are broken down by the enzyme DPP-4, which is found throughout the body and does not require a functioning kidney to work.
The researchers’ results were what one would expect: better blood sugar, good kidney function and weight loss. The researchers recommend a larger randomized trial, which would be great, but for now this is good data that GLP-1 receptor agonists are safe in this population that has a second lease on life.
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Campana M, et al. Efficacy and safety of glucagon-like peptide-1 receptor agonist in patients with diabetes who underwent kidney transplantation: A retrospective study with a control group. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 4-6, 2023; Seattle.
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