S THIRUVENGADAM1; K BENNETT1; A CHAKERA1
1Sir Charles Gairdner Hospital, Perth, Western Australia
Aim: To compare the insulin resistance in patients treated with DPP-4 therapy to a historical cohort of patients receiving other treatment for NODAT.
Background: The use of corticosteroids and calcineurin-inhibitors to prevent rejection after renal transplant predisposes patients to insulin resistance. Within the first year, almost half of patients are affected by new onset diabetes after transplant (NODAT). Although DPP-4 inhibitors have shown efficacy in protecting beta cells from tacrolimus-induced toxicity, there is limited data on their clinical application in this population.
Methods: Seventeen out of the 36 patients who received a renal transplant between October 2015 and August 2016 had NODAT. Nine of them were treated with a DPP-4 inhibitor as part of a new clinical pathway and had Homeostatic Model Assessment – Insulin Resistance (HOMA-IR) scores available. A second historical cohort of 43 patients transplanted between 2008 and 2015 had HOMA-IR scores available. Nine patients in this cohort developed NODAT and received metformin, insulin and/or gliclazide. The HOMA-IR scores between these two cohorts of patients were compared.
Results: The HOMA-IR scores of patients without NODAT did not differ significantly between the two cohorts suggesting that their baseline characteristics were similar. Patients with NODAT treated with DPP-4 inhibitor therapy had significantly better (p<0.02) HOMA-IR scores (mean 2.35) than those in the historical cohort treated with other agents (mean 4.07). Furthermore, there was no difference in HOMA score between patients with NODAT receiving DPP-4 inhibitor therapy and patients without NODAT in the same cohort.
Conclusion: This study suggests that linagliptin monotherapy could reduce the risk of insulin resistance after transplant. A larger randomized controlled trial should be undertaken to validate these results.