Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients.Lo, C., et al.
Cochrane Database of Systematic Reviews 2020; 8: CD009966.
The aim of this study was to assess the safety and efficacy of glucose-lowering agents in the treatment of pre-existing and new-onset diabetes among renal transplant patients.
Electronic searches were carried out on 16 January 2020 using the Cochrane Kidney and Transplant Register of Studies, which contained studies identified from MEDLINE, CENTRAL, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal, ClinicalTrials.gov, and conference proceedings. Study selection and data extraction were done by two independent authors.
10 studies were included in the review.
The primary outcomes included transplant or graft survival, glycated haemoglobin A1c (HbA1c), fasting blood glucose (FBG), delayed graft function, and markers of kidney function including estimated glomerular filtration rate (eGFR), albuminuria and creatinine. The secondary outcomes included death (by any cause), macrovascular and microvascular events, lipids, systolic and diastolic blood pressure (BP), bodyweight, and quality of life. The safety outcomes included medication discontinuation due to adverse events, hypoglycaemia, oedema, cancer events, lactic acidosis, gastrointestinal side effe
This is a good quality Cochrane systematic review that followed the standard protocols. The database searches were wide-reaching, papers were sifted in duplicate and data extraction was completed in duplicate. Ten studies (603 patients in total) were included. Seven of the studies were assessed as being at high risk of bias. Overall, the evidence for glucose-lowering therapy after transplantation is limited, and no strong recommendations are made by the authors. It is suggested that glucose-control be individualized, tailoring medication choice to the severity of hyperglycaemia and risk of interaction with other drugs. Good quality RCTs comparing the safety and efficacy of a wide range of glucose-lowering agents are needed, as are RCTs comparing different insulin regimens in the post-operative period.