Cochrane · systematic review · CD009966
Glucose‐lowering agents for treating pre‐existing and new‐onset diabetes in kidney transplant recipients
Lo, C, Toyama, T, Oshima, M, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
40
current version
GRADE rated
27
No studies
13
Included studies
NR
No studies 13 · 32.5%Ungraded 0 · 0%Very low 16 · 40%Low 8 · 20%Moderate 3 · 7.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyMore intensive versus less intensive insulin therapy for treating pre‐existing and new‐onset diabetes in kidney transplant recipients
Population: pre‐existing and new‐onset diabetes in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival More intensive vs less intensive insulin therapy | RR 1.12 [0.32, 3.94] | 4 studies · 301 participants | Very low Downgraded: risk of bias |
Delayed graft function Time frame: 1 to 3 years More intensive vs less intensive insulin therapy | RR 0.63 [0.42, 0.93] | 2 studies · 153 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
HbA1c Time frame: 13 months More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FBG (mmol/L) Time frame: 13 months More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Kidney function markers: creatinine, eGFR Time frame: 1 year More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Death (any cause) Time frame: 1 to 5 years More intensive vs less intensive insulin therapy | RR 0.68 [0.29, 1.58] | 3 studies · 208 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Hypoglycaemia Time frame: 13 months to 5 years More intensive vs less intensive insulin therapy | no estimate extracted | 4 studies · 301 participants | Very low Downgraded: risk of bias |
Discontinuation of medication due to adverse events Time frame: 1 year More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
DPP‐4 inhibitors versus placebo for treating pre‐existing and new‐onset diabetes in kidney transplant recipients
Population: pre‐existing and new‐onset diabetes in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival DPP‐4 inhibitors vs placebo | no estimate extracted | NR | No studies |
Delayed graft function DPP‐4 inhibitors vs placebo | no estimate extracted | NR | No studies |
HbA1c Time frame: 3 months DPP‐4 inhibitors vs placebo | no estimate extracted | 1 study · 32 participants | Low Downgraded: imprecision |
FBG Time frame: 3 months DPP‐4 inhibitors vs placebo | no estimate extracted | 1 study · 32 participants | Low Downgraded: imprecision |
Kidney function markers DPP‐4 inhibitors vs placebo | no estimate extracted | 1 study · 32 participants | Low Downgraded: imprecision |
Death (any cause) DPP‐4 inhibitors vs placebo | no estimate extracted | NR | No studies |
Hypoglycaemia Time frame: 8 to 16 weeks DPP‐4 inhibitors vs placebo | no estimate extracted | 2 studies · 51 participants | Very low Downgraded: imprecision |
Discontinuation of medication due to adverse events Time frame: 8 to 16 weeks DPP‐4 inhibitors vs placebo | no estimate extracted | 2 studies · 51 participants | Very low Downgraded: imprecision |
DPP‐4 inhibitors versus insulin glargine for treating pre‐existing and new onset diabetes in kidney transplant recipients
Population: pre‐existing and new onset diabetes in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival DPP‐4 inhibitors vs insulin glargine | no estimate extracted | NR | No studies |
Delayed graft function DPP‐4 inhibitors vs insulin glargine | no estimate extracted | NR | No studies |
HbA1c Time frame: 12 weeks DPP‐4 inhibitors vs insulin glargine | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias |
FBG Time frame: 12 weeks DPP‐4 inhibitors vs insulin glargine | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias |
Kidney function markers DPP‐4 inhibitors vs insulin glargine | no estimate extracted | NR | No studies |
Death (any cause) DPP‐4 inhibitors vs insulin glargine | no estimate extracted | NR | No studies |
Hypoglycaemia Time frame: 12 weeks DPP‐4 inhibitors vs insulin glargine | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias |
Discontinuation due to adverse events Time frame: 12 weeks DPP‐4 inhibitors vs insulin glargine | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias |
SGLT2 inhibitors versus placebo for treating pre‐existing and new‐onset diabetes in kidney transplant recipients
Population: pre‐existing and new‐onset diabetes in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival SGLT2 inhibitors vs placebo | no estimate extracted | 1 study · 44 participants | Moderate Downgraded: imprecision |
Delayed graft function SGLT2 inhibitors vs placebo | no estimate extracted | NR | No studies |
HbA1c Time frame: 24 weeks SGLT2 inhibitors vs placebo | no estimate extracted | 1 study · 44 participants | Low Downgraded: imprecision |
FBG (mmol/L) Time frame: 24 weeks SGLT2 inhibitors vs placebo | no estimate extracted | 1 study · 44 participants | Low Downgraded: imprecision |
Kidney function markers SGLT2 inhibitors vs placebo | no estimate extracted | 1 study · 44 participants | Low Downgraded: imprecision |
Death (any cause) SGLT2 inhibitors vs placebo | no estimate extracted | NR | No studies |
Hypoglycaemia Time frame: 24 weeks SGLT2 inhibitors vs placebo | no estimate extracted | 1 study · 44 participants | Moderate Downgraded: imprecision |
Discontinuation of medication due to adverse events Time frame: 24 weeks SGLT2 inhibitors vs placebo | no estimate extracted | 1 study · 49 participants | Moderate Downgraded: imprecision |
Glitazones and insulin versus placebo and insulin for treating pre‐existing and new onset diabetes in kidney transplant recipients
Population: pre‐existing and new onset diabetes in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival Glitazones and insulin vs placebo and insulin | no estimate extracted | NR | No studies |
Delayed graft function Glitazones and insulin vs placebo and insulin | no estimate extracted | NR | No studies |
HbA1c Time frame: 16 weeks Glitazones and insulin vs placebo and insulin | no estimate extracted | 1 study · 62 participants | Very low |
FBG (mmol/L) Time frame: 16 weeks Glitazones and insulin vs placebo and insulin | no estimate extracted | 2 studies · 120 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Kidney function markers Glitazones and insulin vs placebo and insulin | no estimate extracted | 1 study · 62 participants | Very low |
Death (any cause) Glitazones and insulin vs placebo and insulin | no estimate extracted | NR | No studies |
Hypoglycaemia Glitazones and insulin vs placebo and insulin | no estimate extracted | NR | No studies |
Discontinuation of medication due to adverse events Time frame: 16 weeks Glitazones and insulin vs placebo and insulin | no estimate extracted | 1 study · 71 participants | Low |
More intensive versus less intensive insulin therapy for treating pre‐existing and new‐onset diabetes in kidney transplant recipients
Population: kidney transplant recipients with pre‐existing type 1 or type 2 diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival More intensive vs less intensive insulin therapy | no estimate extracted | 2 studies · 192 participants | Very low Downgraded: risk of bias, imprecision |
Glycated haemoglobin More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 49 participants | Very low Downgraded: risk of bias, imprecision |
Fasting blood glucose More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 49 participants | Very low Downgraded: risk of bias, imprecision |
Kidney function: creatinine level, eGFR, albuminuria More intensive vs less intensive insulin therapy | no estimate extracted | NR | No studies |
All‐cause mortality More intensive vs less intensive insulin therapy | no estimate extracted | 1 study · 99 participants | Very low Downgraded: risk of bias, imprecision |
Macrovascular and microvascular events: cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke, new or worsening kidney disease, retinopathy More intensive vs less intensive insulin therapy | no estimate extracted | NR | No studies |
Safety: hypoglycaemia, discontinuation of medication due to adverse events, gastrointestinal side effects, congestive heart failure, oedema, lactic acidosis, liver abnormalities/failure, cancer events, other adverse events as described by authors More intensive vs less intensive insulin therapy | no estimate extracted | 3 studies · 241 participants | Very low Downgraded: risk of bias, imprecision |
DPP4 inhibitors versus placebo or other glucose‐lowering agents for treating pre‐existing or new‐onset diabetes in kidney transplant recipients
Population: kidney transplant recipients with new‐onset diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | 2 studies · 70 participants | Low Downgraded: risk of bias, imprecision |
Glycated haemoglobin DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | 2 studies · 77 participants | Low Downgraded: risk of bias, imprecision |
Fasting blood glucose DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | 2 studies · 77 participants | Low Downgraded: risk of bias, imprecision |
Kidney function: creatinine levels, eGFR, albuminuria DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | 2 studies · 70 participants | Low Downgraded: risk of bias, imprecision |
All‐cause mortality DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | 2 studies · 70 participants | Low Downgraded: risk of bias, imprecision |
Macrovascular and microvascular events: cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke, new or worsening kidney disease, retinopathy. DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | NR | No studies |
Safety events: hypoglycaemia, discontinuation of medication due to adverse events, gastrointestinal side effects, congestive heart failure, oedema, lactic acidosis, liver abnormalities/failure, cancer events, other adverse events as described by a... DPP4 inhibitors vs placebo or other glucose‐lowering agents | no estimate extracted | 3 studies · 115 participants | Low Downgraded: risk of bias, imprecision |
Pioglitazone versus placebo for treating pre‐existing or new‐onset diabetes in kidney transplant recipients
Population: kidney transplant recipients with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Transplant or graft survival Pioglitazone vs placebo | no estimate extracted | NR | No studies |
Glycated Haemoglobin Pioglitazone vs placebo | no estimate extracted | 1 study · 62 participants | Low |
Fasting blood glucose Pioglitazone vs placebo | no estimate extracted | 1 study · 62 participants | Low |
Kidney function: creatinine level, eGFR, albuminuria Pioglitazone vs placebo | no estimate extracted | 1 study · 62 participants | Low |
All‐cause mortality Pioglitazone vs placebo | no estimate extracted | NR | No studies |
Macrovascular and microvascular complications: cardiovascular death, non‐fatal myocardial infarction (MI), non‐fatal stroke, new or worsening kidney disease, retinopathy Pioglitazone vs placebo | no estimate extracted | NR | No studies |
Safety: hypoglycaemia, discontinuation of medication due to adverse events, gastrointestinal side effects, congestive heart failure, oedema, lactic acidosis, liver abnormalities/failure, cancer events, other adverse events as described by authors Pioglitazone vs placebo | no estimate extracted | 1 study · 62 participants | Low |