The Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
University of Sydney, Sydney, New South Wales, Australia.
Diabetes Care. 2023 Jun 1;46(6):1292-1299. doi: 10.2337/dc22-2202.
Checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM) is a distinct form of autoimmune diabetes that is a rare complication of immune checkpoint inhibitor therapy. Data regarding CIADM are limited.
To systematically review available evidence to identify presentation characteristics and risk factors for early or severe presentations of adult patients with CIADM.
MEDLINE and PubMed databases were reviewed.
English full text articles from 2014 to April 2022 were identified with a predefined search strategy. Patients meeting diagnostic criteria for CIADM with evidence of hyperglycemia (blood glucose level >11 mmol/L or HbA1c ≥6.5%) and insulin deficiency (C-peptide <0.4 nmol/L and/or diabetic ketoacidosis [DKA]) were included for analysis.
With the search strategy we identified 1,206 articles. From 146 articles, 278 patients were labeled with "CIADM," with 192 patients meeting our diagnostic criteria and included in analysis.
Mean ± SD age was 63.4 ± 12.4 years. All but one patient (99.5%) had prior exposure to either anti-PD1 or anti-PD-L1 therapy. Of the 91 patients tested (47.3%), 59.3% had susceptibility haplotypes for type 1 diabetes (T1D). Median time to CIADM onset was 12 weeks (interquartile range 6-24). DKA occurred in 69.7%, and initial C-peptide was low in 91.6%. T1D autoantibodies were present in 40.4% (73 of 179) and were significantly associated with DKA (P = 0.0009) and earlier time to CIADM onset (P = 0.02).
Reporting of follow-up data, lipase, and HLA haplotyping was limited.
CIADM commonly presents in DKA. While T1D autoantibodies are only positive in 40.4%, they associate with earlier, more severe presentations.
免疫检查点抑制剂相关自身免疫性糖尿病（CIADM）是一种独特的自身免疫性糖尿病形式，是免疫检查点抑制剂治疗的罕见并发症。关于 CIADM 的数据有限。
系统回顾现有证据，以确定成人 CIADM 患者早期或严重表现的特征和危险因素。
对 MEDLINE 和 PubMed 数据库进行了检索。
采用预定义的检索策略，确定了 2014 年至 2022 年 4 月的英文全文文章。符合 CIADM 诊断标准且有高血糖（血糖水平＞11mmol/L 或 HbA1c≥6.5%）和胰岛素缺乏（C 肽＜0.4nmol/L 和/或糖尿病酮症酸中毒[DKA]）证据的患者纳入分析。
通过检索策略，我们共确定了 1206 篇文章。在 146 篇文章中，有 278 例患者被标记为“CIADM”，其中 192 例符合我们的诊断标准并纳入分析。
患者的平均年龄为 63.4±12.4 岁。除 1 例患者外（99.5%），所有患者均有抗 PD1 或抗 PD-L1 治疗史。在接受检测的 91 例患者中（47.3%），59.3%有 1 型糖尿病（T1D）易感单倍型。CIADM 发病的中位时间为 12 周（四分位距 6-24）。69.7%发生 DKA，91.6%初始 C 肽水平低。T1D 自身抗体阳性率为 40.4%（73/179），与 DKA（P=0.0009）和更早的 CIADM 发病时间（P=0.02）显著相关。
随访数据、脂肪酶和 HLA 单倍型报告有限。
CIADM 常以 DKA 为首发表现。虽然 T1D 自身抗体的阳性率仅为 40.4%，但它们与更早期、更严重的表现相关。
