A Meta-analysis of Novel Glucose-Lowering Therapies in Kidney Transplant Recipients with Diabetes
American Diabetes Association 85th Scientific Sessions, Illinois, Amerika Birleşik Devletleri, 21 - 23 Haziran 2025, ss.834, (Tam Metin Bildiri)
- Yayın Türü: Bildiri / Tam Metin Bildiri
- Doi Numarası: 10.2337/db25-834-p
- Basıldığı Şehir: Illinois
- Basıldığı Ülke: Amerika Birleşik Devletleri
- Sayfa Sayıları: ss.834
- Hacettepe Üniversitesi Adresli: Evet
Özet
Introduction and Objective: The efficacy of novel therapies like glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) for kidney transplant recipients (KTR) with diabetes remains uncertain. We aimed to perform a systematic review and meta-analysis to assess the efficacy and safety of GLP-1 RA and SGLT2i in these individuals.
Methods: PubMed, EMBASE, Cochrane Central, and clinicaltrials.gov were systematically searched for studies using GLP-1 RA or SGLT2i in KTR with diabetes. We computed mean difference (MD) and standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using Comprehensive Meta-analysis version 3.3.070.
Results: We included 22 studies, comprising 5287 participants, of whom 291 underwent GLP-1 RA therapy and 3211 underwent SGLT2i therapy. After 12 months of GLP-1 RA therapy, participants had significantly lower glycated hemoglobin (HbA1c) (SMD: −0.34; 95% CI: −0.60, −0.75; p=0.012), reduced insulin requirement (MD: −7.34 U; 95% CI: −12.42; −2.26; p=0.005), and body weight (MD: −3.25 kg; 95% CI: −5.07, −1.43; p<0.001) but a similar estimated glomerular filtration rate (eGFR). Sixteen percent of individuals experienced adverse gastrointestinal side effects while receiving GLP1-RA. The use of SGLT2i was associated with a significantly reduced HbA1c (SMD: −0.31; 95% CI: −0.49, −0.15; p<0.001), body weight (MD: −2.29 kg; 95% CI: −3.17, −1.41; p<0.001), and adverse cardiovascular events (RR: 0.38; 95% CI: 0.25, 0.57; p<0.001). There were no significant differences in eGFR and genitourinary infections.
Conclusion: In KTR with diabetes, the use of GLP-1 RA and SGLT2i was associated with better glycemic control, reduced body weight, and reduced insulin requirement, presenting an acceptable safety profile and optimized care.