Ma Yuhong, Xue Jing, Cheng Qianwen, Qian Hesheng, Du Yingying
Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Oncology, Fuyang Cancer Hospital, Fuyang, China.
Front Endocrinol (Lausanne). 2025 Jul 4;16:1589630. doi: 10.3389/fendo.2025.1589630. eCollection 2025.
This report aims to better define the rare adverse event of immune checkpoint inhibitor-associated diabetes mellitus(ICI-DM). We present 10 cases of patients including six of the patients had no prior history of diabetes, while four had varying degrees of pre-existing diabetes. Eight who received anti-PD-1 combination therapy, one who received anti-PD-1 monotherapy, and one who received dual anti-PD-1/CTLA-4 therapy. The mean time from initiation of immunotherapy to the onset of ICI-DM was 245.4 days (median, 149 days; range, 11 to 787 days). Diabetic ketoacidosis (DKA) occurred in 60% (6/10) of the patients, with a median fasting blood glucose level of 25.85 mmol/L (range, 14.76 to 38.23 mmol/L), and all had C-peptide levels below the normal range. Through a retrospective analysis of the clinical data of these 10 patients, we found that monitoring fasting blood glucose and HbA1c is crucial for patients undergoing or having undergone immunotherapy, as rapid pancreatic β-cell destruction can be observed in those who develop ICI-DM, potentially due to disruption of the PD-1/PD-L1 pathway.
本报告旨在更明确地界定免疫检查点抑制剂相关糖尿病（ICI-DM）这一罕见不良事件。我们呈现了10例患者的情况，其中6例患者既往无糖尿病史，4例有不同程度的糖尿病前期。8例接受抗PD-1联合治疗，1例接受抗PD-1单药治疗，1例接受抗PD-1/CTLA-4双药治疗。从免疫治疗开始至ICI-DM发病的平均时间为245.4天（中位数为149天；范围为11至787天）。60%（6/10）的患者发生糖尿病酮症酸中毒（DKA），空腹血糖水平中位数为25.85 mmol/L（范围为14.76至38.23 mmol/L），且所有患者的C肽水平均低于正常范围。通过对这10例患者临床资料的回顾性分析，我们发现，对于正在接受或已经接受免疫治疗的患者，监测空腹血糖和糖化血红蛋白至关重要，因为在发生ICI-DM的患者中可观察到胰腺β细胞迅速破坏，这可能是由于PD-1/PD-L1通路的破坏所致。
