Post-transplant diabetes mellitus (PTDM) has shown associations with diabetes-related risk factors like – obesity and tacrolimus-based immunosuppression, which decrease pancreatic insulin secretion. A number of sodium-glucose-linked transporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP1-RAs) markedly improve the outcomes of type 2 diabetes (T2D) in individuals with and without chronic kidney disease (CKD). CKD, HF, and atherosclerotic cardiovascular disease (ASCVD) are differentially affected by SGLT2is and GLP1-RAs. 

The present study reviewed recent studies with SGLT2is in PTDM, with known moderate-to-low safety and antihyperglycemic efficacydepending on kidney function in this population. The findings indicated that GLP1-RAs are ideal for PTDM patients suffering from obesity. 

The major proportion of data included in this review was derived from kidney transplant recipients. Moreover, Moreover, the choice of drug in this patient population should be based on the preponderance of CKD, ASCVD or HF. Patients with a higher predilection of ASCVD should receive a GLP1‐RA. The advantages of SGLT2i is proven in those predisposed to HF or CKD should receive an.

Additionally, evidence suggests that SGLT2is can potentially be used in PTDM with close monitoring. On the other hand, for only retrospective case reports of PTDM are available for GLP1‐Ras, which show no serious safety concerns. 

Source: Transplant international. 2021 Jan;34(1):27-48. doi: 10.1111/tri.13783.