GLP-1 Receptor Agonists (GLP-1RAs) in Kidney-Transplanted (KTX) People with Diabetes: Ad Interim Results of an 18-Month Trial

Introduction and Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are recommended as first-line therapy for type 2 diabetes due to their glycemic, cardioprotective, renoprotective, and weight-reducing effects. However, evidence supporting their use in post-transplant diabetes mellitus (PTDM) remains limited. The aim of this prospective, single-center study was to evaluate the efficacy and safety of GLP-1RAs in kidney-transplanted (KTx) people with PTDM. Methods: Forty-two KTx adults with PTDM were enrolled and evaluated at baseline and after 6, 12, and 18 months following initiation of GLP-1RA therapy. At each visit, clinical history, anthropometric parameters, laboratory data, and body composition assessed by bioelectrical impedance analysis were collected. Primary endpoints were changes in glycated hemoglobin (HbA1c) and body mass index (BMI). At the interim analysis, 37 participants completed the 6-month follow-up and 32 completed the 18-month evaluation. Results: HbA1c significantly decreased by −0.6% at 6 months (95% CI −0.8 to −0.4), −0.7% at 12 months (95% CI −0.9 to −0.4), and −0.7% at 18 months (95% CI −1.0 to −0.5; p<0.001). BMI was reduced by −1.9 kg/m² at 6 and 12 months and by −1.8 kg/m² at 18 months (all p<0.001). Overall, 59.4% of participants achieved >5% body weight loss at study completion. Significant reductions were also observed in body weight, fasting plasma glucose, and waist circumference. No serious adverse events were reported; one participant discontinued treatment due to lipase levels >3× the upper limit of normal. Conclusion: GLP-1RAs appear to be effective and safe for the treatment of PTDM in kidney-transplanted individuals. Larger studies with longer follow-up are needed to assess their impact on cardiovascular and renal outcomes in this population. Disclosure: I. Cogliati: None. A. Oliverio: None. A. Gaglio: None. V. Resi: None. E. Orsi: None. V. Grancini: None.