Longitudinal observation of insulin secretory ability before and after the onset of immune checkpoint inhibitor‐induced diabetes mellitus: A report of two cases

Fujiwara, Noriko; Watanabe, Mayu; Katayama, Akihiro; Noda, Yoichi; Eguchi, Jun; Kataoka, Hitomi; Kagawa, Shunsuke; Wada, Jun

doi:10.1002/ccr3.4574

Cited by 3 publications

(2 citation statements)

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“…On the other hand, Fujiwara et al have described changes in insulin secretion dynamics after initiation of treatment with ICIs in patients who subsequently developed DM-ICIs [ 38 ], so that C-peptide monitoring in at-risk patients may be a strategy to consider. HbA1c monitoring during the pre-DM-ICIs period is not recommended, given the tendency to normal values for this parameter at the time of diagnosis (related to the abrupt onset of the condition) [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice

Vera-Gómez

Piñar-Gutiérrez

Guerrero-Vázquez

et al. 2022

Journal of Diabetes Research

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Objectives. The aim of this study is to investigate in depth diabetes mellitus associated with immune checkpoint inhibitors (DM-ICIs) by analysing a case series. We also evaluated the clinical impact of flash glucose monitoring (FGM) systems in the management of this entity. Methods. We conducted an observational cohort study of DM-ICIs diagnosed in two hospitals in Seville (Spain). Patients with a new diagnosis of diabetes mellitus (DM) or with sudden worsening of preexisting DM after starting treatment with ICIs, with a random 5 hour-postprandial C-peptide value of <0.6 nmol/L and without possibility of subsequent withdrawal of insulin treatment, were included. Results. A total of 7 cases were identified, mostly males ( n = 6 ; 85.7%), with a mean age of 64.9 years. The mean glycated hemoglobin (HbA1c) upon diagnosis was 8.1%, with diabetic ketoacidosis (DKA) observed in 6 cases (85.7%). Subcutaneous flash glucose monitoring (FGM) systems were used in six cases, with a mean follow-up period of 42.7 weeks. During the first 90 days of use, mean average glucose was 167.5 mg/dL, with a coefficient of variation (CV) of 34.6%. The mean time in the range 70-180 mg/dL (TIR) was 59.7%, with a mean time above range (TAR) 181-250 mg/dL of 27.8% and a mean TAR > 250 mg / dL of 10.2%. The mean time below range (TBR) 54-69 mg/dL was 2%, while the mean TBR < 54 mg / dL was 0.3%. The mean glucose management indicator (GMI) was 7.3%. No significant differences were observed in FGM values for the following 90 days of follow-up. A progressive improvement in all parameters of glycaemic control was observed between the first month of FGM use and the sixth month of FGM use. Of note, there was a decrease in mean CV (40.6% to 34.1%, p = 0.25 ), mean TAR 181-250 (30.3% to 26%, p = 0.49 ), mean TAR > 250 mg / dL (16.3% to 7.7%, p = 0.09 ), mean TBR 54-69 mg/dL (5.2% to 2%, p = 0.16 ), and mean TBR < 54 mg / dL (1.8% to 0.2%, p = 0.31 ), along with an increase in mean values of TIR 70-180 mg/dL (46.5% to 60.5%, p = 0.09 ). The lack of statistical significance in the differences observed in the mean FGM values over the follow-up period may be related to the small sample size. Conclusion. DM-ICI is recognised by a state of sudden-onset insulinopenia, often associated with DKA. The use of FGM systems may be a valid option for the effective management of DM-ICIs and for the prevention of severe hyperglycaemic and hypoglycaemic episodes in this condition.

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Section: Discussionmentioning

confidence: 99%

Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice

Vera-Gómez

Piñar-Gutiérrez

Guerrero-Vázquez

et al. 2022

Journal of Diabetes Research

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“…Большой интерес представляет тот факт, что у многих пациентов возникало более одного связанного с иммунитетом нежелательного явления во время лечения анти-PD-1 -терапией, причем чаще всего был зарегистрирован аутоиммунный тиреоидит. Это наблюдение наводит на мысль о повышенной уязвимости аутоиммунитета в данной популяции [32][33][34][35].…”

Section: Discussionunclassified

Anti-PD‑1-induced type 1 diabetes mellitus in patient with recurrent oropharyngeal squamous cell cancer

Lyanova¹,

Vladimirova²,

Абрамова³

et al. 2023

Medicinskij alfavit

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Ростов-на-Дону 2 Больница Christiana Care, г. Ньюарк, штат Делавэр, США РЕЗЮМЕ Ингибиторы иммунных контрольных точек, нацеленные на запрограммированный лиганд гибели клеток PD-L1, стали крупным прорывом в лечении многих онкологических заболеваний. Ниволумаб -это антитело, избирательно блокирующее рецептор PD-1 на поверхности цитотоксических Т-клеток для предотвращения подавления регуляции иммунного ответа. Известно, что ингибиторы иммунных контрольных точек могут вызывать так называемые иммуноопосредованные нежелательные явления, в том числе со стороны эндокринной системы. Сахарный диабет 1 типа является одним из тяжелых редких и потенциально опасных для жизни иммуноопосредованных нежелательных явлений, встречающихся менее чем у 1 % пациентов, получающих лечение ингибиторами иммунных контрольных точек. Хотя общая частота сахарного диабета 1 типа, связанного с ингибитором PD-1, относительно низка, тем не менее он имеет молниеносное течение и может представлять потенциальную угрозу для жизни пациентов, если не будут проведены своевременная диагностика и лечение. Поскольку ингибиторы PD-1 широко используются для лечения многих злокачественных заболеваний, осложнения в виде диабета 1 типа должны привлекать внимание врачей. Кроме того, нельзя не учитывать тот факт, что в ходе лечения врачи должны помогать пациентам лучше распознавать симптомы гипергликемии или диабетического кетоацидоза, что требует тщательного наблюдения за ними во время лечения, регулярного мониторинга уровня глюкозы в плазме крови, оперативного выявления и правильной диагностики и лечения диабета.

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Antineoplastics

2022

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Longitudinal observation of insulin secretory ability before and after the onset of immune checkpoint inhibitor‐induced diabetes mellitus: A report of two cases

Abstract: Immune checkpoint inhibitor‐induced diabetes mellitus is a rare immune‐related adverse event. This report illustrates clinical data and insulin secretory ability before and after the onset of immune checkpoint inhibitor‐induced diabetes.

Cited by 3 publications

References 40 publications

Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice

Flash Glucose Monitoring and Diabetes Mellitus Induced by Immune Checkpoint Inhibitors: An Approach to Clinical Practice

Anti-PD‑1-induced type 1 diabetes mellitus in patient with recurrent oropharyngeal squamous cell cancer

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