Glucagon-like Peptide-1 Receptor Agonists in Heart Transplant Recipients With Type 2 Diabetes: A Multicenter Study
Zorba Blazquez-Bermejo, Daniel Enríquez-Vázquez, Elena García-Romero, Cristina Mitroi, Andrea Severo, Iris María Esteve Ruiz, María Angeles Castel, Julia Martínez Solé, Maria del Val Groba Marco, Iris P. Garrido-Bravo, Ana Marcén Miravete, Beatriz Díaz Molina, Clara Simón-Ramón, Gonzalo Cabezón Villalba, Carlos Ortiz-BautistaBackground.
Type 2 diabetes mellitus (T2DM) is frequent after heart transplantation (HT) and is exacerbated by immunosuppressive therapy. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may improve metabolic control, but data in HT recipients are limited.
Methods.
We performed a retrospective, multicenter study including HT recipients with T2DM from 14 Spanish centers. In patients treated with GLP-1 RAs, we assessed antidiabetic and immunosuppressive therapies, adverse events, and changes in metabolic parameters, insulin dose, and immunosuppressant trough levels during the first year after GLP-1 RA initiation.
Results.
Among 734 HT recipients with T2DM (2011–2021), 108 (14.7%) received GLP-1 RAs (mean age 55.4 ± 9.0 y; 79.6% male), initiated 4.0 ± 3.1 y post-HT. At baseline, 64.8% had obesity. Semaglutide was used in 59%, dulaglutide in 27%, liraglutide in 13%, and tirzepatide in 1%; 41.7% achieved the maximum therapeutic dose. After 1 y, significant reductions were observed in body weight (–6.2 kg; 95% confidence interval [CI], –7.7 to –4.5 kg), fasting glucose (–27 mg/dL; 95% CI, –41 to –7 mg/dL), glycated hemoglobin (–0.74%; 95% CI, –1.12% to –0.35%), total cholesterol (–12 mg/dL; 95% CI, –19 to –6 mg/dL), low-density lipoprotein cholesterol (–8 mg/dL; 95% CI, –14 to –2 mg/dL), triglycerides (–29 mg/dL; 95% CI, –53 to –5 mg/dL), and systolic blood pressure (–3.6 mm Hg; 95% CI, –6.4 to –0.9 mm Hg). Tacrolimus trough levels decreased modestly (–0.7 ng/mL; 95% CI, –1.4 to –0.1 ng/mL;
Conclusions.
In HT recipients with T2DM, GLP-1 RAs were associated with improved glycemic and cardiometabolic parameters and were generally well tolerated. These findings support the use of GLP-1 RAs as a valuable therapeutic strategy for the management of T2DM after HT.