SAT-629 Treatment of Prediabetes and Obesity with Tirzepatide in a Patient with History of Type 1 Diabetes with Pancreas and Kidney Transplant

Abstract Disclosure: J. Liu: None. S. Bao: None. Background/Introduction: Simultaneous pancreas-kidney transplantation (SPK) is indicated in patients with Type 1 diabetes (T1DM) complicated by End Stage Renal Disease (ESRD), however obesity and abnormal glucose homeostasis may persist after SPK. The efficacy and tolerability of Glucagon-like peptide -1 receptor agonist (GLP-1 RA) in patients with history of T1DM after SPK is not well characterized. We present a case of T1DM whose diabetes went into remission after a SPK but had worsening obesity and developed prediabetes 4 years later that was successfully treated with GLP-1 RA. Clinical Case: The patient was a 41-year-old female with T1DM diagnosed at age 8, complicated with diabetic nephropathy, ESRD, retinopathy and neuropathy with a toe amputation. She received a SPK at age 37. The patient’s glucose profile, hemoglobin A1c (HbA1c), and renal function normalized and she was able to stop insulin therapy within 6 months after SPK. However, she had difficulty losing weight while taking prednisone for transplant immune suppression. Four years after receiving SPK, her Body-Mass-Index (BMI) increased to 36.2 kg/m2 , and her HbA1C trended upwards to 6.3%, with fasting c-peptide of 2.9 ng/mL (c-peptide < 0.1 ng/ml before SPK). She was started on a GLP-1 RA Tirzepatide 2.5mg weekly with improvement of her overall metabolic and glucose profile. Her BMI improved to 32.3 kg/m2, HbA1C improved to 5.6%, and c-peptide increased to 3.8ng/mL 6 weeks later, and she tolerated Tirzapatide well. She continued to do well on this treatment so far, 6 months after. Discussion: GLP-1 RAs have been approved to treat Type 2 diabetes and obesity and have also been shown to have cardiovascular and renal benefits. There is also ongoing investigation on the use of GLP-1 RA in the treatment of obese, insulin resistant T1DM. Improved glucose and insulin homeostasis after pancreas transplantation can be disrupted due to rejection or recurrence autoimmune process and optimal management of glucose in this population is not well-established. There was a previous case series of improved glucose homeostasis and metabolic results in T1DM recipients of pancreas transplant treated with Liraglutide, a short-acting GLP-1 RA. Our case highlights GLP-1 RA could be beneficial in patient with pre-diabetes and obesity after SPK, via mechanisms such as stimulating insulin section, improving insulin sensitivity and weight loss. Additionally, treatment with GLP-1 RA may lead to lower risk of hypoglycemia compared to oral diabetes medications such as sulfonylureas since GLP-1 RA’s stimulation of insulin secretion is glucose-dependent. More studies are needed to assess the long-term efficacy and safety of GLP-1 RA in T1DM patients after SPK. Presentation: Saturday, July 12, 2025