Management of post-transplant diabetes mellitus (PTDM) remains challenging because of elevated cardiovascular and renal risk and limited long-term evidence for newer glucose-lowering therapies. A single-center retrospective observational study published in Diabetes Therapy evaluated the long-term effectiveness and safety of sodium-glucose cotransporter-2 (SGLT2) inhibitors in solid organ transplant recipients with diabetes.

The study included 86 transplant recipients treated with SGLT2 inhibitors between January 2017 and July 2025. Efficacy analyses included 70 patients who received treatment for at least 6 months. Outcomes included changes in HbA1c, body weight, systolic blood pressure, estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (uACR), treatment modifications, and safety events.

Findings

• Participants had a mean age of 65.9 years, and 72 of 86 participants were men. Mean follow-up duration was 1.6 ± 1.4 years.
• Significant HbA1c reduction was observed only between years 2 and 3 of follow-up, with a reduction of 0.6% from baseline.
• Body weight decreased significantly during follow-up (P=0.007), with a maximum reduction of 5.5 kg.
• No significant changes were observed in systolic blood pressure or uACR during follow-up.
• Estimated glomerular filtration rate declined progressively over time (P<0.001), although only 4 patients experienced a decline of at least 50%.
• Urogenital infections occurred in 7% of patients (5.1 cases per 100 person-years) and led to treatment discontinuation in 4.6%. Overall treatment discontinuation occurred in 19.8% of patients.

In this real-world cohort of patients with PTDM, SGLT2 inhibitor therapy was associated with sustained weight reduction and delayed glycemic improvement during follow-up. The observed decline in renal function warrants further evaluation in prospective controlled studies.