Management of post-transplant diabetes mellitus: an opportunity for novel therapeutics

Post-transplant diabetes mellitus (PTDM) is a common problem after kidney transplantation (KT). The clinical importance of PTDM depends on its impact as a significant risk factor for cardiovascular and chronic kidney disease (CKD) post solid organ transplantation. Updated treatment guidelines of Kidney Disease: Improving Global Outcomes (KDIGO) has put light on the newer antidiabetic agents for diabetes management in CKD. Hence, Nuria Montero and colleagues published a research paper in the Clinical Kidney Journal under the title “Management of post-transplant diabetes mellitus: an opportunity for novel therapeutics”. The summary of this paper is given below:

Objective:

To evaluate and provide guidance on DM management in KT recipients.

Method:

The research paper was developed from the currently available evidence and scientific and medical knowledge.

Findings:

Intensive blood glucose monitoring and flexible and safe treatment algorithms are required in PTDM patients due to rapidly changing conditions.

Incretin Agents

A)Glucagon-like peptide-1 receptor agonists (GLP-1 RA)

Renal Benefits: some studies show that GLP-1 RA delays reduction in eGFR levels and decreases albuminuria. These findings need validation.
Cardiovascular Benefits: While there is a need for further research, GLP-1RA may decrease cardiovascular events.
Metabolic Impact: GLP-1RA increase insulin secretion and decrease glucagon secretion, with better glycemic control. It also helps in weight loss.

B)Dipeptidyl peptidase-4 inhibitors (DPP4i)

Renal Benefits: It was found to decrease albuminuria in some studies.
Metabolic Impact: DPP4i helps in decreasing insulin resistance and β-cell dysfunction. It decreases insulin requirements and improves glycemic control. Helps in Weight loss.

C)Sodium-Glucose Co-transporter 2 (SGLT2i)

Renal Benefits: It may decrease hyperfiltration and albuminuria.
Cardiovascular Benefits: It may decrease systolic blood pressure.
Metabolic Impact: It helps in weight loss.

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