*Purpose: Post-transplant diabetes mellitus (PTDM) occurs in up to 50% of recipients and is associated with increased mortality and poor outcomes after transplantation. The management of PTDM is complex and often requires a multidisciplinary approach. The purpose of this study is to describe clinical outcomes and DM medication utilization of solid organ transplant (SOT) recipients followed at the University of San Diego Health (UCSDH) PTDM Clinic.
*Methods: A retrospective cohort study assessing adult (> 18 years of age) SOT recipients referred to the UCSDH PTDM clinic from 1/1/2020 to 8/31/22 was conducted. The PTDM Clinic manages complicated DM SOT patients in the early post-transplant period and includes an endocrinologist, transplant pharmacist, dietician, and a certified diabetes educator. Demographic, transplant, and DM information pre- and post-transplant were assessed. Use of antihyperglycemics including renal and cardioprotective agents (GLP1RA and SGLT2i) were characterized. Clinical outcomes were compared at the time of transplant and then at PTDM clinic discharge. Comparisons were made with the McNeamer test for nominal data and paired t-tests or Wilcoxon signed-rank test for continuous data. All p-values < 0.05 were considered statistically significant.
*Results: Eighty-two patients were analyzed. A majority of patients were male (67.1%) with type 2 DM (85.4%) and had a median age of 58.7 years (IQR 50.6 - 64.7 years). Demographics and transplant information are included in Table 1. Use of antihyperglycemics is detailed in Table 2. Patients were first seen in clinic at a median of 28.5 days (IQR 19 - 50 days) post-transplant discharge. Utilization of renal and CV-protective DM medications increased significantly after PTDM oversight (19.4% vs 80.6%, p < 0.001) in addition to continuous glucose monitor use (17.1% vs 57.3%, p < 0.001). Furthermore, there were reductions in weight (p <0.001) and the incidence of patients on insulin (p < 0.001). Despite this, there were no differences in A1c from baseline to PTDM clinic discharge (p = 0.95). Table 3 includes PTDM clinical outcome information.
*Conclusions: The PTDM multidisciplinary clinic yielded a higher incidence of patients being prescribed renal and cardioprotective antihyperglycemics compared to pre-transplant. CGM utilization was also higher in the post-transplant period. Additionally, there was a significant reduction in weight over the course of the clinic period. Future studies are needed to determine the long-term effects of a dedicated PTDM clinic.

Janice Kerr

University of California San Diego Health

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