Glucagon-Like Peptide-1 Receptor Agonists Compared to Insulin for Post-Transplant Diabetes Mellitus After Solid Organ Transplant

Pre-existing diabetes mellitus (DM) prior to solid organ transplant (SOT) and development of post-transplant diabetes mellitus (PTDM) is common. The use of novel agents, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA), has increased in the general population due to beneficial effects on cardiovascular disease (CVD) and weight loss. However, there is limited data in the SOT population. A retrospective, observational, matched cohort study in outpatient SOT recipients on injectable diabetes therapy was performed at a single academic medical center. The purpose of the study was to compare glycemic control in SOT recipients using a GLP-1-RA-containing regimen compared with insulin-only when initiated within 12 months of transplant. Seventy patients were included in the analysis with 51% of subjects in each group reaching their A1c goal within 1 year after starting diabetes therapy. The median A1c was 7.0% in the GLP-1 RA group and 6.9% in the insulin only group (P = .30). One year after starting diabetes therapy, insulin use decreased to 69% in the GLP-1 RA group, while 94% of subjects in the insulin only group remained on insulin (P = .007). There were 7.2 fewer injections per week in the GLP-1 RA group compared to 4.6 more in the insulin group (P < 0.001). In SOT recipients within 12 months of transplant, the use of GLP-1 RA for blood glucose management had the same A1C goal attainment as insulin-only while allowing for fewer injections per week.