Safety and Efficacy of Sitagliptin for the Treatment of New-Onset Diabetes (NODAT) in Kidney Transplant Recipients

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 834-867-Islet Biology
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-865
Brian Paul Boerner*, Clifford D Miles and Vijay Shivaswamy
University of Nebraska Med Cntr, Omaha, NE
New-onset diabetes after transplantation (NODAT) is a common co-morbid condition after kidney transplant (KTx) associated with decreased graft survival, increased cardiovascular disease risk, and increased mortality (1).  Non-insulin options for treatment of NODAT in KTx recipients are limited due to co-morbidities and potential effects on immunosuppressant (IS) levels.  Three months of therapy with sitagliptin (SGT) has been shown to be safe and efficacious in treatment of NODAT in KTx recipients (2).  Longer-term effects of SGT in this population are not clear.  We performed a retrospective analysis of KTx recipients at UNMC who developed NODAT and were subsequently treated with SGT to establish efficacy and safety after 12 months of follow up.  Between 10/2006 and 12/2011, 22 KTx recipients diagnosed with NODAT by ADA criteria were initiated on SGT therapy alone.  Most patients (n=18) utilized combination IS regimens of tacrolimus + sirolimus or mycophenolate mofetil.  Patients were 44.7±2.5 years at time of KTx, had BMI of 32.2±1.5 kg/m2 at NODAT diagnosis, and NODAT diagnosis was made 56.3±12.3 months after transplant.  SGT was started 12.7±3.3 months after diagnosis of NODAT.  Wilcoxon signed rank test was used to analyze differences between start of STG and 12 month follow up and Friedman test was employed for repeated measures analysis (Prism 4 software, Graph Pad®).  From initiation of SGT to 12-month follow up, hemoglobin A1c improved from 6.8±0.1% to 6.4±0.1% (p<0.05) and 19/22 patients were maintained on SGT alone.  One patient required an additional oral hypoglycemic agent, and 2 patients discontinued SGT due to hyperglycemia requiring insulin therapy.  No patients discontinued due to side effects.  Tacrolimus (n=19) and sirolimus (n=9) trough levels and dosages were unchanged during the follow up period (p=NS).  Renal graft function remained stable, serum Cr 1.5±0.1 at baseline compared to 1.6±0.1 at end of follow up (p=NS).  A significant drop in BMI occurred over the follow up period (32.6±1.5 to 31.6±1.5 kg/m2, p<0.05).  No graft loss occurred and no significant hypoglycemia was reported by patients or noted on fasting serum glucose measurements.  No change was seen in LDL or HDL cholesterol levels (p=NS).  In conclusion, our study is the first to report 12-month safety and efficacy of SGT for treatment of NODAT in a cohort of KTx recipients.  Our findings suggest SGT could be utilized as a first-line agent in this setting.

(1) Ghisdal L et al., Diabetes Care 2012; 35:181. (2) Lane JT et al., Transplantation 2011; 92:e56.

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