Change in Effectiveness and Safety Parameters After Initiation of SGLT2 Inhibitors for Post-Transplant Diabetes Mellitus: A Real-World Observational Study

INTRODUCTION: Post-transplant diabetes mellitus (PTDM) is frequent and associated with increased cardiovascular and renal risk. Evidence regarding the long-term effectiveness and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in PTDM remains limited. METHODS: We conducted a single-center retrospective observational study including 86 solid organ transplant recipients with diabetes treated with SGLT2 inhibitors between January 2017 and July 2025. Seventy patients who received treatment for ≥ 6 months were included in efficacy analyses. The primary endpoint was change in HbA1c over time. Secondary endpoints included changes in body weight, systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (uACR), treatment modifications, and safety outcomes. RESULTS: Participants (72/86 men; mean age 65.9 years) were followed for a mean of 1.6 ± 1.4 years. A significant HbA1c reduction was observed only between years 2 and 3 (- 0.6% vs baseline), while overall longitudinal variation was not statistically significant. Body weight significantly decreased over time (p = 0.007), with a maximum reduction of - 5.5 kg. No significant changes were observed in SBP or uACR. A progressive decline in eGFR was detected during follow-up (p < 0.001), but only four patients had a ≥ 50% eGFR decline. Urogenital infections occurred in 7% of patients (5.1 cases/100 person-years), leading to treatment discontinuation in 4.6%. Overall discontinuation rate was 19.8%. CONCLUSION: In this real-world descriptive study on PTDM, initiation of an SGLT2 inhibitor was followed by sustained weight reduction and delayed glycemic improvement, with an acceptable safety profile. The observed long-term renal decline warrants further investigation in controlled prospective studies.