Israel Study: SGLT2 Inhibitors Show Promise for Kidney Transplant Patients With Diabetes

A study from Israel has shed important light on a pressing question facing thousands of American diabetes patients who have received kidney transplants: can they safely take a popular class of diabetes medications known as SGLT2 inhibitors?

Researchers at the Institute of Endocrinology, Diabetes and Metabolism at Rabin Medical Center — affiliated with Tel Aviv University — followed 240 kidney transplant recipients with diabetes over three years, comparing those who took SGLT2 inhibitors (brand names include Jardiance, Farxiga, and Invokana) against those on standard diabetes therapy.

What Are SGLT2 Inhibitors?

SGLT2 inhibitors work by causing the kidneys to filter excess glucose out through urine, lowering blood sugar levels. Beyond blood sugar control, they have become widely praised for protecting kidney function in people with diabetic kidney disease. The American Diabetes Association (ADA) currently recommends SGLT2 inhibitors as a preferred add-on therapy for patients with type 2 diabetes and chronic kidney disease — but guidance for kidney transplant recipients has remained murky due to safety uncertainties, particularly around the risk of urinary tract infections (UTIs).

What the Israeli Research Found

The Israeli team found that kidney transplant recipients taking SGLT2 inhibitors experienced notably better blood sugar (glycemic) control compared to the standard treatment group. On a practical level, this is significant: poorly controlled blood sugar after transplant is a known driver of graft failure and other complications.

In terms of serious kidney-related events — including dialysis, re-transplantation, acute kidney failure, or acute rejection — SGLT2 users had a lower raw event rate (8.9 events per 100 patient-years versus 13.3 in non-users). After statistical adjustment for other health factors, the difference evened out (HR 0.99), meaning both groups carried similar adjusted risk. Critically, SGLT2 users did not face higher rates of UTIs, fractures, amputations, diabetic ketoacidosis, or death.

Understanding the Numbers: A US Context

For reference, healthy fasting blood glucose in US guidelines is under 100 mg/dL (5.6 mmol/L), with a diabetes diagnosis at 126 mg/dL (7.0 mmol/L) or higher. The ADA recommends an A1C target of below 7% for most adults with diabetes. Kidney transplant recipients in this Israeli study who used SGLT2 inhibitors moved meaningfully closer to these targets compared to peers on standard therapy.

Why This Matters for US Patients

Approximately 25,000 kidney transplants are performed in the United States each year, and diabetes is both a leading cause of kidney failure and a common post-transplant complication. Yet kidney transplant recipients are routinely excluded from the landmark clinical trials that established SGLT2 inhibitors as kidney-protective drugs. This leaves American physicians and patients with little evidence to guide treatment decisions for this vulnerable group.

The Israeli findings — from a real-world, three-year follow-up — help fill that gap. They suggest that SGLT2 inhibitors can be used in kidney transplant patients with diabetes without meaningfully increasing the risks that doctors worry about most. While this was a retrospective study (not a randomized controlled trial), its size and duration make it one of the more robust datasets available on this topic. Ongoing randomized trials will provide stronger confirmation.

American patients with diabetes who have received or are awaiting a kidney transplant should discuss this emerging evidence with their transplant nephrologist and endocrinologist to determine whether SGLT2 inhibitors may be appropriate for their care plan.

Citation

Diker Cohen, Polansky, Bergman. Safety of sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients with diabetes mellitus. Diabetes & Metabolism (2025). DOI: 10.1016/j.diabet.2025.101627. PMID: 39956453.