Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
Diabetes Obes Metab. 2024 Oct;26(10):4261-4272. doi: 10.1111/dom.15769. Epub 2024 Jul 26.
To investigate the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors in liver transplant (LT) recipients with diabetes.
A single-centre, retrospective analysis of prospectively collected data from an LT recipient database (1990-2023) was conducted. We included adults with pre-existing diabetes and post-transplant diabetes, newly started on GLP-1RAs and/or SGLT2 inhibitors after LT. Metabolic and biochemical parameters and outcomes were collected for up to 12 months after starting medications and were compared to those in patients receiving dipeptidyl peptidase-4 (DPP-4) inhibitors. Statistical analysis included descriptive statistics and linear mixed models.
We included participants on GLP-1RAs (n = 46), SGLT2 inhibitors (n = 87), combination therapy (n = 12), and a DPP-4 inhibitor comparator (n = 217). Both GLP-1RAs and combination therapy decreased mean glycated haemoglobin (HbA1c) levels, and combination therapy remained significant when adjusted for DPP-4 inhibitor treatment (-3.5%, 95% CI [-6.1, -0.95]; p = 0.0089) at 12 months. All three groups had significant decreases in mean weight and body mass index, but these remained significant in the GLP-1RA (-5.2 kg, 95% CI [-8.7, -1.7], p = 0.0039 and 1.99 kg/m, 95% CI [-3.4, -0.6], p = 0.0048) and combination therapy groups (-5.4 kg, 95% CI [-10.5, -0.36], p = 0.04 and -3.4 kg/m, 95% CI [-5.5, -1.3], p = 0.0015) when adjusted for DPP-4 inhibitor treatment at 12 months. Alanine aminotransferase levels decreased with GLP-1RA and combination therapy. There were two (1.4%) cases of graft rejection.
We found that GLP-1RAs, SGLT2 inhibitors, and their combination, led to significant weight loss in LT recipients with diabetes. Combination therapy, in particular, lowered HbA1c and alanine aminotransferase levels compared to DPP-4 inhibitors. Further studies are needed to assess long-term safety and efficacy.
研究胰高血糖素样肽-1 受体激动剂（GLP-1RAs）和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂在肝移植（LT）受者糖尿病中的疗效和安全性。
对 1990 年至 2023 年 LT 受者数据库中前瞻性收集的数据进行单中心回顾性分析。我们纳入了患有糖尿病和移植后糖尿病的成年人，他们在 LT 后开始使用 GLP-1RAs 和/或 SGLT2 抑制剂。收集了药物治疗开始后长达 12 个月的代谢和生化参数及结果，并与接受二肽基肽酶-4（DPP-4）抑制剂治疗的患者进行了比较。统计分析包括描述性统计和线性混合模型。
我们纳入了使用 GLP-1RAs（n=46）、SGLT2 抑制剂（n=87）、联合治疗（n=12）和 DPP-4 抑制剂比较组（n=217）的参与者。GLP-1RAs 和联合治疗均降低了平均糖化血红蛋白（HbA1c）水平，且联合治疗在调整 DPP-4 抑制剂治疗后仍具有显著意义（-3.5%，95%CI[-6.1，-0.95]；p=0.0089），12 个月时仍有显著意义。三组患者的平均体重和体重指数均有显著下降，但 GLP-1RA 组（-5.2kg，95%CI[-8.7，-1.7]，p=0.0039 和 1.99kg/m，95%CI[-3.4，-0.6]，p=0.0048）和联合治疗组（-5.4kg，95%CI[-10.5，-0.36]，p=0.04 和-3.4kg/m，95%CI[-5.5，-1.3]，p=0.0015）在调整 DPP-4 抑制剂治疗后仍有显著意义。GLP-1RAs 和联合治疗可降低丙氨酸氨基转移酶水平。有 2 例（1.4%）发生移植物排斥。
我们发现 GLP-1RAs、SGLT2 抑制剂及其联合治疗可显著降低 LT 受者糖尿病患者的体重。与 DPP-4 抑制剂相比，联合治疗尤其能降低 HbA1c 和丙氨酸氨基转移酶水平。还需要进一步研究来评估长期安全性和疗效。
