Glycemic, renal, and graft outcomes with dulaglutide versus multiple daily insulin therapy after kidney transplantation in type 2 diabetes.

AIMS: This study evaluated the real-world outcomes of dulaglutide in combination with basal insulin, compared to multiple daily injection (MDI) insulin regimen in kidney transplantation recipients with preexisting type 2 diabetes. METHODS: This retrospective cohort study included patients with type 2 diabetes who underwent kidney transplantation between 2016 and 2022. MDI users were matched with basal insulin plus dulaglutide users in a 1:1 ratio using propensity scores. Outcome measures included glycemic control, weight change, renal function, and graft outcomes. RESULTS: After matching, 142 patients (71 in each group) were analyzed. Glycosylated hemoglobin A1c remained stable in the basal insulin/dulaglutide group, whereas it increased at 24 months in the MDI group (+0.61 % [+6.7 mmol/mol] in the MDI group vs. +0.06 % [+0.7 mmol/mol] in the basal insulin/dulaglutide group; p = 0.02). The basal insulin/dulaglutide group achieved greater weight reduction (+1.07 kg vs. -4.93 kg; p < 0.0001). The basal insulin/dulaglutide showed improvements in eGFR, although the differences were not statistically significant after matching. Kidney graft outcomes were not significantly different between the two groups. CONCLUSION: Once-weekly dulaglutide successfully replaced prandial insulin after kidney transplantation, providing better long-term glycemic stability, greater weight reduction, improved renal parameters, and similar graft outcomes, while reducing injection burdens.