GLP-1 Receptor Agonists and SGLT2 Inhibitors in Stable Kidney Transplantation: Clinical Outcomes from a Cohort of Patients with Post-Transplant Diabetes Mellitus

<b>Background:</b> Despite the lack of formal indication for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in post-transplant diabetes mellitus (PTDM), their use in clinical practice is growing. While robust evidence supporting their use in kidney transplant recipients (KTRs) remains limited, PTDM remains a major driver of adverse outcomes, including cardiovascular morbidity, accelerated graft dysfunction, graft loss, and reduced survival. <b>Methods:</b> This retrospective cohort study analyzed adult KTRs with PTDM treated with SGLT2is and/or GLP-1 RAs between 2013 and 2024. Metabolic, kidney, and safety parameters were assessed from baseline to follow-up. <b>Results:</b> After a median treatment duration of 1.8 years, glycated hemoglobin (HbA1c) changed from 7.22% to 7.01% (<i>p</i> = 0.558), whereas fasting plasma glucose increased from 112.62 mg/dL to 125.01 mg/dL (<i>p</i> = 0.03). Body mass index decreased from 27.27 kg/m² to 25.95 kg/m² (<i>p</i> < 0.001). The lipid profile improved, with reductions in total cholesterol (<i>p</i> < 0.01) and low-density lipoprotein cholesterol (LDL-c, <i>p</i> = 0.02). Kidney function remained stable throughout the observation period, and adverse events were infrequent. <b>Conclusions:</b> In KTRs with PTDM, GLP-1 RAs and SGLT2is were associated with significant improvements in weight and lipid metabolism, alongside stable kidney function and a favorable safety profile. These findings support the consideration of these agents in the management of PTDM. Prospective studies are warranted to confirm these results.