ORIGINAL RESEARCH article
Front. Med.
Sec. Nephrology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1653147
This article is part of the Research TopicExploring kidney pathology in transplantation: Spotlight on non-neoplastic conditions and DCD donor qualityView all articles
Comparative Efficacy and Safety of Antidiabetic Agents for Post-Transplant Diabetes Mellitus: A Network Meta-Analysis
Provisionally accepted
Shanbiao Hu*
Gongbin Lan- Second Xiangya Hospital, Central South University, Changsha, China
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Background: Post-transplant diabetes mellitus (PTDM) significantly compromises patient and graft outcomes. Although multiple antidiabetic agents are available, their comparative efficacy and safety profiles in this population remain uncertain.Methods: A systematic literature search was performed across PubMed, Web of Science, Embase, and Cochrane Library to identify clinical trials comparing antidiabetic therapies in PTDM patients. Risk of bias was assessed, and a network metaanalysis was conducted to estimate relative treatment effects. Treatment ranking probabilities, contribution plots, and funnel plots were used to evaluate hierarchy, study influence, and publication bias, respectively.Results: Twelve studies-including 10 randomized controlled trials (RCTs) and 2 cohort studies-encompassing 7,372 patients were analyzed. The network metaanalysis evaluated four outcomes: HbA1c, fasting plasma glucose (FPG), systolic blood pressure (SBP), and composite major adverse cardiovascular and kidney events (MACE and MAKE). Compared to placebo, insulin produced the greatest reductions in HbA1c (mean difference [MD] -0.35%, 95% CI -0.90 to 0.20) and FPG (MD -9.06 mmol/L, 95% CI -18.66 to 0.53). DPP-4 inhibitors showed the most pronounced decrease in SBP (MD -3.57 mmHg, 95% CI -7.29 to 0.16). SGLT2 inhibitors (SGLT2i) demonstrated the strongest tendency to reduce MACE and MAKE events (MD -1.95, 95% CI -4.85 to 0.96). SUCRA plots indicated that insulin and SGLT2i ranked highest in glycemic control and safety profiles. Funnel plot analysis suggested a low risk of publication bias.Conclusions: Insulin and SGLT2i represent the most efficacious and safest options among antidiabetic treatments for PTDM, supporting their preferential consideration in post-transplant diabetes management. Further large-scale, head-to-head trials are warranted to strengthen these findings.
Keywords: New-onset diabetes after transplantation, Antidiabetic agents, Network meta-analysis, SGLT2I, Insulin
Received: 24 Jun 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Hu and Lan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shanbiao Hu, Second Xiangya Hospital, Central South University, Changsha, China
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