Linagliptin plus insulin for hyperglycemia immediately after renal transplantation: A comparative study

Guardado-Mendoza, Rodolfo; Cázares-Sánchez, David; Jiménez-Ceja, Lilia M.; Durán-Pérez, E. G.; Aguilar-García, Alberto

doi:10.1016/j.diabres.2019.107864

Cited by 10 publications

(10 citation statements)

References 32 publications

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“…In KTRs with hyperglycemia 5 days after transplantation (>140 mg/dL), insulin doses were lower with linagliptin and insulin compared with insulin alone (24.2 vs 37.5 units; P < 0.05). 23 Early treatment with DPP-4 inhibitors may improve insulin resistance in KTRs with PTDM. With intensive monitoring to detect PTDM, linagliptin was initiated earlier at a median of 90 days posttransplantation.…”

Section: Dipeptidyl Peptidase-4 Inhibitorsmentioning

confidence: 99%

“…22,24,48 As for guidance on when these agents can be safely initiated, the earliest initiation of DPP-4 inhibitors occurred immediately posttransplant, whereas it took around 1 year for GLP-1 RAs to be initiated. 23,48 For their initiation, there appears to be a lack of clinically significant effects with DPP-4 inhibitors and GLP-1 RAs on CNI trough concentrations. [27][28][29]49,50 Providers need to consider prevalent GI AEs, which could worsen mycophenolateinduced GI distress and affect patient quality of life.…”

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

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Review of Newer Antidiabetic Agents for Diabetes Management in Kidney Transplant Recipients

et al. 2020

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Objective This systematic review describes the efficacy, safety, and drug interactions of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose transport protein 2 (SGLT2) inhibitors in kidney transplant recipients (KTRs). Data Sources Articles were identified by English-language MEDLINE search, published prior to May 2020, using the terms kidney transplant, OR PTDM, OR NODAT, AND metformin, OR DPP4, OR GLP1, OR SGLT2. Study Selection and Data Extraction All selected studies were included if the study population was composed of adult KTRs who were diagnosed with either impaired glucose tolerance, diabetes mellitus (DM), new-onset diabetes after transplant (NODAT), or posttransplantation diabetes mellitus (PTDM). Data Synthesis In KTRs, there is evidence for safety with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors. However, urinary tract infections and a slight initial decrease in renal function may limit use of SGLT2 inhibitors. As compared with the nontransplant type 2 DM population, SGLT2 inhibitors are not as efficacious in KTRs. Relevance to Patient Care and Clinical Practice This review provides an overview of the current literature on newer antidiabetic agents, addressing efficacy, safety, and drug interactions to help guide clinical decision-making for their use in KTRs. Conclusion Newer antidiabetic agents have been recommended by the American Diabetes Association for potential cardiovascular, renal, and hypoglycemic benefits. Particular agents, such as DPP-4 inhibitors and GLP-1 RAs may play a role in correcting PTDM-related defects. Clinicians need to take into account both patient-specific and drug-specific characteristics when initiating these agents in KTRs.

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Section: Dipeptidyl Peptidase-4 Inhibitorsmentioning

confidence: 99%

Section: Relevance To Patient Care and Clinical Practicementioning

confidence: 99%

Review of Newer Antidiabetic Agents for Diabetes Management in Kidney Transplant Recipients

et al. 2020

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“…Based on previous observational and retrospective reports by Solerte and Mirani, on the effect of DPP-4 inhibitors on prognosis in hospitalized patients with COVID-19 a minimum of 35 patients per group were needed for 5% significance level and 80% statistical power and considering a 20% of expected loss during follow-up 43 , 44 . This sample size had also the statistical power to find any significant difference in glucose levels between groups, considering data from a previous study carried out in hospitalized kidney transplant patients 16 , in which it was observed that the linagliptin + insulin group had a final glucose level of 135 ± 14 mg/dl whereas the insulin-only group had a glucose level of 155 ± 19 mg/dl.…”

Section: Methodsmentioning

confidence: 99%

“…In recent years, the usefulness of new drugs in hospitalized patients with hyperglycemia has been further evaluated 16 . Dipeptidyl peptidase type-4 (DPP-4) is an enzyme found on the cell surface that interacts with different peptide hormones in the regulation of the immune response 17 , 18 .…”

Section: Introductionmentioning

confidence: 99%

“…One of its main known effects is the inactivation of endogenous incretins (GLP-1 and GIP), which increases the half-life of endogenous GLP-1, stimulates insulin secretion by pancreatic beta cells and reduces glucagon secretion by pancreatic alpha cells 19 . Different studies have also shown the usefulness of DPP-4 inhibitors (linagliptin) both in preventing T2D in patients with prediabetes 20 , and in reducing insulin requirements and improving metabolic control in patients with in-hospital hyperglycemia after kidney transplantation when combined with insulin 16 , and they are mainly indicated for uncontrolled patients with T2D who do not meet glucose control 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

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Effect of linagliptin plus insulin in comparison to insulin alone on metabolic control and prognosis in hospitalized patients with SARS-CoV-2 infection

Guardado-Mendoza

Garcia-Magaña

Martínez-Navarro

et al. 2022

Sci Rep

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To evaluate the effect of the combination of linagliptin and insulin on metabolic control and prognosis in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hyperglycemia. A parallel double-blind randomized clinical trial including hospitalized patients with SARS-CoV-2 infection and hyperglycemia, randomized to receive 5 mg linagliptin + insulin (LI group) or insulin alone (I group) was performed. The main outcomes were the need for assisted mechanical ventilation and glucose levels during hospitalization. Subjects were screened for eligibility at hospital admission if they were not with assisted mechanical ventilation and presented hyperglycemia, and a total of 73 patients with SARS-CoV-2 infection and hyperglycemia were randomized to the LI group (n = 35) or I group (n = 38). The average hospital stay was 12 ± 1 vs 10 ± 1 days for the I and LI groups, respectively (p = 0.343). There were no baseline clinical differences between the study groups, but the percentage of males was higher in the LI group (26 vs 18, p = 0.030). The improvements in fasting and postprandial glucose levels were better in the LI group that the I group (122 ± 7 vs 149 ± 10, p = 0.033; and 137 ± 7 vs 173 ± 12, p = 0.017, respectively), and insulin requirements tended to be lower in the LI group than the I group. Three patients in the LI group and 12 in the I group required assisted mechanical ventilation (HR 0.258, CI 95% 0.092–0.719, p = 0.009); 2 patients in the LI group and 6 in the I group died after a follow-up of 30 days (p = 0.139). No major side effects were observed. The combination of linagliptin and insulin in hospitalized patients with SARS-CoV-2 infection and hyperglycemia reduced the relative risk of assisted mechanical ventilation by 74% and improved better pre and postprandial glucose levels with lower insulin requirements, and no higher risk of hypoglycemia.This study is registered at clinicaltrials.gov, number NCT04542213 on 09/03/2020.

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Management of new onset dysglycemia in transplant recipients

Sharif

2024

Metabolic Syndrome

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Linagliptin plus insulin for hyperglycemia immediately after renal transplantation: A comparative study

Cited by 10 publications

References 32 publications

Review of Newer Antidiabetic Agents for Diabetes Management in Kidney Transplant Recipients

Review of Newer Antidiabetic Agents for Diabetes Management in Kidney Transplant Recipients

Effect of linagliptin plus insulin in comparison to insulin alone on metabolic control and prognosis in hospitalized patients with SARS-CoV-2 infection

Management of new onset dysglycemia in transplant recipients

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