Largest single‐centre experience of dulaglutide for management of diabetes mellitus in solid organ transplant recipients

Singh, Priyamvada; Pesavento, Todd E.; Washburn, K. W.; Walsh, Debbie; Meng, Shumei

doi:10.1111/dom.13619

Cited by 54 publications

(71 citation statements)

References 12 publications

(33 reference statements)

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“…Our data shows that GLP-1RA improved glycemic control, with improvements in HbA1c (-0.75%) and decreases in total daily dose of insulin (16.25 units) 12 months from baseline in SOT recipients. The number of oral medications decreased with GLP-1RA initiation, similar to results reported by Singh et al [12]. We saw reductions in weight and BMI in our cohort by a mean of 4.86 kg and 1.63 kg/m 2 , respectively, at the end of 12 months.…”

Section: Discussionsupporting

confidence: 90%

“…Our results are similar to those of Pinelli et al [11], who reported a small case series of five patients that received co-administration of liraglutide with tacrolimus post kidney transplant; liraglutide did not clinically affect the trough tacrolimus levels. Singh et al [12] also reported in their study of dulaglutide in SOT recipients that the immunosuppressant regimen remained stable without any increased dose adjustment. This is in contrast to the Liou et al [10] study of five patients on liraglutide after kidney transplant, who reported that three patients could reduce the dose of tacrolimus and maintain optimal therapeutic levels.…”

Section: Discussionmentioning

confidence: 90%

“…Hence, they are theoretically safe because the chances of interaction with immunosuppressant medications are low. GLP-1RA are an attractive option for management of post-transplant diabetes, although only a small number of studies evaluated GLP-1RA for this condition [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Study of Glucagon-Like Peptide 1 Receptor Agonists for the Management of Diabetes After Transplantation

2020

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Introduction: Management of post-transplant diabetes mellitus is challenging; there is a lack of prospective randomized controlled trials for safety and efficacy of antidiabetic medications in solid organ recipients. Glucagon-like peptide 1 receptor agonists (GLP-1RA) are a relatively new class of medications used to manage type 2 diabetes in the general population. They have several benefits besides glycemic control, including weight loss and improved cardiovascular risk. However, they have not been studied extensively in the post-transplant population for safety and efficacy. Methods: We conducted a retrospective study of patients who had received kidney, liver, or heart transplant, had diabetes either pre-or post-transplant, and were treated with GLP-1RA. We identified seven kidney, seven liver, and five heart transplant recipients who had received GLP-1RA. We assessed changes in immunosuppressant levels, rejection episodes, changes in hemoglobin A1c (HbA1c), weight, and body mass index (BMI) while on the GLP-1RA. We also looked at changes in insulin dose, other diabetes medications, heart rate, blood pressure, and renal function. Results: After a mean follow-up period of 12 months, there were no significant changes in tacrolimus (FK506) levels and renal function for the period of GLP-1RA use. At the end of 12 months, the mean drop in weight was 4.86 kg [95% CI -7.79, -1.93]. The BMI decreased by a mean of 1.63 kg/m 2 at the end of 12 months [95% CI -2.53, -0.73]. HbA1c decreased from baseline by 1.08% [95% CI -1.65, -0.51], 0.96% [95% CI -1.68, -0.25], and 0.75% [95% CI -1.55, 0.05] at 3, 6, and 12 months, respectively. Conclusions: Our data suggest that GLP-1RA do not affect tacrolimus levels or transplant outcomes in solid organ transplant (SOT) recipients in the short term. GLP-1RA also seem to be as effective in SOT recipients for glycemic control and weight loss as in the non-transplant population with diabetes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 90%

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A Retrospective Study of Glucagon-Like Peptide 1 Receptor Agonists for the Management of Diabetes After Transplantation

2020

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“…Given their glucose‐lowering ability, decreased risk of hypoglycemia and minimal drug interactions, they are widely used in the general population. A few retrospective studies, including one from our research group, have demonstrated the safety and effectiveness of GLP‐1 analogues in SOT . Some studies have compared the various GLP‐1 analogues in a general population, but, to date, there have been no comparative studies in the SOT population .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the glucagon‐like‐peptide‐1 receptor agonists dulaglutide and liraglutide for the management of diabetes in solid organ transplant: A retrospective study

Singh

Taufeeq

Pesavento

et al. 2020

Diabetes Obesity Metabolism

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Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining popularity in the management of diabetes in solid organ transplant (SOT) recipients. There are no studies available comparing the two GLP-1RAs dulaglutide and liraglutide in SOT. We performed a retrospective chart review to assess the safety and effectiveness of these agents in adult SOT with diabetes at 6, 12 and 24 months. There were 63 and 25 recipients on dulaglutide and liraglutide, respectively. There was a sustained

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“…No hypoglycemia was noticed. Until now, the largest case series (63 recipients who had received Dulaglutide regardless of the time of onset of diabetes with respect to a transplant) to be reported was published in 2018 [65]. The baseline renal function was good, 1.55 mg/dL of Scr.…”

Section: Glp-1r For Recipientsmentioning

confidence: 99%

Management of Diabetes Mellitus in Normal Renal Function, Renal Dysfunction and Renal Transplant Recipients, Focusing on Glucagon-Like Peptide-1 Agonist: A Review Based upon Current Evidence

Tsai

Chen

2019

IJMS

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Diabetes Mellitus (DM) is a leading cause of both Cardiovascular Disease (CVD) and End-stage Renal Disease (ESRD). After 2008, there has been much evidence presented, and recently the guidelines for sugar control have changed to focus on being more disease orientated. GLP-1 Receptor Agonists (GLP-1R) and sodium glucose cotransporter-2 inhibitors are suggested as the first line towards fighting all DM, CVD and ESRD. However, the benefits of GLP-1R in organ transplantation recipients remain very limited. No clinical trials have been designed for this particular population. GLP-1R, a gastrointestinal hormone of the incretin family, possesses antidiabetic, antihypertensive, anti-inflammatory, anti-apoptotic and immunomodulatory actions. There are few drug–drug interactions, with delayed gastric emptying being the major concern. The trough level of tacrolimus may not be significant but should still be closely monitored. There are some reasons which support GLP-1R in recipients seeking glycemic control. Post-transplant DM is due to an impaired β-cell function and glucose-induced glucagon suppression during hyperglycemia, which can be reversed by GLP-1R. GLP-1R infusion tends to relieve immunosuppressant related toxicity. Until now, in some cases, glycemic control and body weight reduction can be anticipated with GLP-1R. Additional renal benefits have also been reported. Side effects of hypoglycemia and gastrointestinal discomfort were rarely reported. In conclusion, GLP-1R could be implemented for recipients while closely monitoring their tacrolimus levels and any potential side effects. Any added benefits, in addition to sugar level control, still require more well-designed studies to prove their existence.

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Largest single‐centre experience of dulaglutide for management of diabetes mellitus in solid organ transplant recipients

Cited by 54 publications

References 12 publications

A Retrospective Study of Glucagon-Like Peptide 1 Receptor Agonists for the Management of Diabetes After Transplantation

A Retrospective Study of Glucagon-Like Peptide 1 Receptor Agonists for the Management of Diabetes After Transplantation

Comparison of the glucagon‐like‐peptide‐1 receptor agonists dulaglutide and liraglutide for the management of diabetes in solid organ transplant: A retrospective study

Management of Diabetes Mellitus in Normal Renal Function, Renal Dysfunction and Renal Transplant Recipients, Focusing on Glucagon-Like Peptide-1 Agonist: A Review Based upon Current Evidence

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