scholarly journals Efficacy and Safety of SGLT-2 Inhibitors for Treatment of Diabetes Mellitus among Kidney Transplant Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 8 (4) ◽  
pp. 47
Author(s):  
Api Chewcharat ◽  
Narut Prasitlumkum ◽  
Charat Thongprayoon ◽  
Tarun Bathini ◽  
Juan Medaura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Blood Pressure ◽  
Body Weight ◽  
Kidney Transplant ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Transplant Patients ◽  
Treatment Of Diabetes ◽  
Kidney Transplant Patients

Background: The objective of this systematic review was to evaluate the efficacy and safety profiles of sodium-glucose co-transporter 2 (SGLT-2) inhibitors for treatment of diabetes mellitus (DM) among kidney transplant patients. Methods: We conducted electronic searches in Medline, Embase, Scopus, and Cochrane databases from inception through April 2020 to identify studies that investigated the efficacy and safety of SGLT-2 inhibitors in kidney transplant patients with DM. Study results were pooled and analyzed utilizing random-effects model. Results: Eight studies with 132 patients (baseline estimated glomerular filtration rate (eGFR) of 64.5 ± 19.9 mL/min/1.73 m2) treated with SGLT-2 inhibitors were included in our meta-analysis. SGLT-2 inhibitors demonstrated significantly lower hemoglobin A1c (HbA1c) (WMD = −0.56% [95%CI: −0.97, −0.16]; p = 0.007) and body weight (WMD = −2.16 kg [95%CI: −3.08, −1.24]; p < 0.001) at end of study compared to baseline level. There were no significant changes in eGFR, serum creatinine, urine protein creatinine ratio, and blood pressure. By subgroup analysis, empagliflozin demonstrated a significant reduction in body mass index (BMI) and body weight. Canagliflozin revealed a significant decrease in HbA1C and systolic blood pressure. In terms of safety profiles, fourteen patients had urinary tract infection. Only one had genital mycosis, one had acute kidney injury, and one had cellulitis. There were no reported cases of euglycemic ketoacidosis or acute rejection during the treatment. Conclusion: Among kidney transplant patients with excellent kidney function, SGLT-2 inhibitors for treatment of DM are effective in lowering HbA1C, reducing body weight, and preserving kidney function without reporting of serious adverse events, including euglycemic ketoacidosis and acute rejection.

scholarly journals Efficacy and Safety of Tirzepatide in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Phase II/III Trials

2021 ◽  
Vol 14 (10) ◽  
pp. 991
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Kota Vidyasagar ◽  
Wubshet Tesfaye
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Body Weight ◽  
Receptor Agonist ◽  
Meta Analysis ◽  
Serum Glucose ◽  
Efficacy And Safety ◽  
Fasting Serum

Tirzepatide is a novel once-a-week dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, currently under trial to assess glycemic efficacy and safety in people with type 2 diabetes. A systematic review and meta-analysis were conducted to investigate the efficacy of tirzepatide on glycated hemoglobin (HbA1c, %), fasting serum glucose (mg/dL), and body weight (kg) in patients with uncontrolled type 2 diabetes (HbA1c > 7.0%). Mean changes for efficacy and proportions (safety) with corresponding 95% confidence intervals (CIs) were used to provide pooled estimates. A total of four randomized controlled trials, comprising 2783 patients of whom 69.4% (n = 1934) were treated with 5 mg (n = 646), 10 mg (n = 641), or 15 mg (n = 647) of tirzepatide, were compared to the placebo (n = 192) or the selective GLP-1 receptor agonist (n = 523). The pooled analysis showed that tirzepatide treatment resulted in a greater lowering of the HbA1c (−1.94%, 95% CI: −2.02 to −1.87), fasting serum glucose (−54.72 mg/dL, 95% CI: −62.05 to −47.39), and body weight (−8.47, 95% CI: −9.66 to −7.27). We also found that improvement in the HbA1c levels was still maintained at weeks 26 and 40 from the long-term trials. As for safety, only 3% experienced hypoglycemia, and 4% (95% CI: 2 to 6) experienced serious adverse events, while the discontinuation of therapy percentage was 7% (95% CI: 5 to 8). Tirzepatide significantly improved glycemic control and body weight and had an acceptable safety profile, indicating that it is an effective therapeutic option for glucose-lowering in patients with type 2 diabetes mellitus.

Efficacy and Safety of Dipeptidyl Peptidase-4 Inhibitors in Kidney Transplant Recipients with Post-transplant Diabetes Mellitus (PTDM)- a Systematic Review and Meta-Analysis

2020 ◽  
Vol 16 (6) ◽  
pp. 580-585 ◽  
Author(s):  
Tarek Samy Abdelaziz ◽  
Ahmed Yamany Ali ◽  
Moataz Fatthy
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Kidney Transplant ◽  
Meta Analysis ◽  
Mean Difference ◽  
Efficacy And Safety ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Dipeptidyl Peptidase 4 ◽  
Post Transplant

Background: Kidney transplant recipients may develop post-transplant diabetes mellitus (PTDM). Dipeptidyl peptidase 4(DPP-4) inhibitors are evolving agents in the management of patients with diabetes mellitus. Aims: To evaluate the efficacy and safety of DPP-4 inhibitors in the management of post-transplant diabetes mellitus (PTDM) in renal transplant recipients. Methods: We performed a systematic search of the electronic databases using keys words and Mesh terms. Data were extracted and reviewed using structured proforma. A comprehensive review of the eligible studies was performed independently by each of two reviewers; conflicts were resolved by the third reviewer. The primary efficacy endpoint was the difference in glycosylated hemoglobin (HbA1c) comparing any of the DPP-4 inhibitors to either placebo or other hypoglycaemic agent. The primary safety endpoints were the worsening of graft functions and change in Tacrolimus trough level. We performed the Random effect model using standardised mean difference. Results: We identified seven studies that were eligible for the systematic review; only one study compared Sitagliptin to insulin Glargine. One study involved head to head comparison of three DPP-4 inhibitors. The other five studies were pooled in the meta-analysis. DPP-4 inhibitors had a favourable glycemic effect as measured by HbA1c when compared to either placebo or oral anti-hyperglycemic medications (standardised mean difference in HbA1c = -0.993, 95% CI= -1.303 to -0.683, P=0.001). DPP-4 inhibitors use did not result in significant change in eGFR ((standardised mean difference = 0.147, 95% CI= -0.139 - 0.433, p=0.312).) nor Tacrolimus level (standardised Mean Difference= 0.152, 95% CI= -0.172 to 0.477, P=0.354). Conclusion: Current evidence supports the short term efficacy and safety of DDP-4 inhibitor agents in the management of post transplantation diabetes mellitus (PTDM) in kidney transplant recipients. However, more RCTs are required to investigate the long-term safety and efficacy of these agents in kidney transplant recipients.

scholarly journals Efficacy and Safety of SGLT2 Inhibitors in Diabetic Kidney Transplant Patients: Review of the Current Literature

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A411-A412
Author(s):  
Shirley Shuster ◽  
Zeyana Al-Hadhrami ◽  
Sara Awad ◽  
Sarah Moore ◽  
Khaled Shamseddin
Keyword(s):  
Blood Pressure ◽  
Glycemic Control ◽  
Literature Review ◽  
Kidney Transplant ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Efficacy And Safety ◽  
Diabetic Kidney ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Abstract Introduction: SGLT2 inhibitors are oral hypoglycemic medications used in type 2 diabetes mellitus (T2DM). They act by blocking glucose and sodium reabsorption in the proximal renal tubules. In patients with T2DM and cardiovascular disease, SGLT2 inhibitors have been shown to improve glycemic control, promote weight loss, and reduce major adverse cardiovascular events (MACE). They have also been shown to have favorable renal outcomes in patients with chronic kidney disease (CKD) reducing albuminuria and progression to end-stage renal disease; however, all studies have excluded kidney transplant patients. The objective of this review was to determine the efficacy and safety of SGLT2 inhibitors in the kidney transplant population. Methods: We conducted a literature review to identify studies which assessed the use of SGLT2 inhibitors in kidney transplant patients with either T2DM or new onset diabetes after transplant (NODAT). The outcomes assessed included blood pressure, glycemic control, body weight, kidney function, proteinuria and complications. Results: Nine studies, which included 144 patients, were extracted for review. These included x4 case series, x3 cohort studies, x1 randomized control trial (RCT), and x1 case report. The largest study was a prospective RCT from Norway, which assessed empagliflozin versus placebo in 44 patients. Majority of patients had NODAT (n=92) or T2DM (n=50). All patients had estimated glomerular filtration rate (eGFR) &gt;30mL/min/1.73m2 and HbA1C &gt;6.5%. The most commonly used SGLT2 inhibitors were empagliflozin (n=82), canagliflozin (n=34), and dapagliflozin (n=28). SGLT2 inhibitor use in kidney transplant patients was found to demonstrate a small or non-significant reduction in blood pressure, modest improvement in glycemic control and decrease in insulin resistance, and moderate-to-significant weight reduction. It also resulted in stable graft function and one study demonstrated a reduction in proteinuria. The most common adverse effect was urinary tract infection (n=13). There were no cases of diabetic ketoacidosis or development of new ischemic lower limb ulcerations or amputations. Conclusion: Our literature review suggests beneficial outcomes of SGLT2 inhibitor use in diabetic kidney transplant patients, with no significant adverse effects or complications. Given the limited evidence in this population, we are launching a prospective study in kidney transplant patients with either T2DM or NODAT, and with eGFR ≥30mL/min/1.73m2, to assess the efficacy and safety of SGLT2 inhibitor use in this population. To our knowledge, this will be the first prospective study in Canada assessing SGLT2 inhibitor use in diabetic kidney transplant patients.

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