Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients.
Lo CM, Jun M, et al.Cochrane Database of Systematic Reviews 2017; 2: CD009966.
Aims
To conduct a systematic review to evaluate the efficacy and safety of pharmacological interventions for lowering glucose levels in diabetic patients who have undergone kidney transplantation.
Interventions
The Cochrane Kidney and Transplant Specialised Register was searched up to 15 April 2016 for all randomised controlled trials (RCTs), quasi-RCTs and cross-over studies which examined head-to-head comparisons of active regimens or active regimen compared with placebo/control/standard care. Eligible studies included adults and children kidney transplant recipients with either type 1 or type 2 diabetes, or new-onset diabetes after transplantation. The abstracts and full texts of included studies were independently assessed by two authors.
Participants
Seven studies were included that involved a total of 399 kidney transplant recipients.
Outcomes
The primary outcomes measured were transplant or graft survival, glycated haemoglobin A1c, fasting blood glucose, creatinine, estimated glomerular filtration rate, albuminuria, systolic and diastolic blood pressure, lipids and body weight. Secondary outcomes included all-cause mortality, macrovascular and microvascular events and safety.
Follow-up
Ranged from 2 months-5 years
CET Conclusions
This careful Cochrane systematic review evaluated the efficacy and safety of glucose-lowering pharmacological interventions for treating pre-existing and new-onset diabetes in kidney transplant recipients. The thorough literature search retrieved 41 studies of which six parallel RCTs and one cross-over RCT met the inclusion criteria. Study eligibility, risk of bias assessment and data extraction was performed by two authors independently. Most studies showed an unclear or high risk of bias. Due to heterogeneity across studies no meta-analysis was performed. Three studies compared more intensive with less intensive insulin therapy, three studies evaluated the use of DPP4 inhibitors and one study examined the effect of pioglitazone for treating pre-existing diabetes or new-onset diabetes after transplantation. The authors rightly concluded that the evidence for the efficacy and safety of the evaluated interventions is limited due to the inclusion of low quality studies and limited data.
Quality notes
Quality assessment not appropriate
Trial registration
None