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24-09-2024 | Checkpoint Inhibitors | Review

Pathophysiology, diagnosis, and management of immune checkpoint inhibitor-induced diabetes mellitus

Authors: Eleni-Rafaela Kani, Eleftheria Karaviti, Dimitra Karaviti, Eleni Gerontiti, Ioanna A. Paschou, Katerina Saltiki, Katerina Stefanaki, Theodora Psaltopoulou, Stavroula A. Paschou

Published in: Endocrine

Abstract

Immune Checkpoint Inhibitors (ICIs) have revolutionized cancer treatment, offering hope for patients with various malignancies. However, along with their remarkable anticancer effects, ICIs can also trigger immune-related adverse events (irAEs). One such noteworthy complication is the development of Diabetes Mellitus (DM), which particularly resembles Type 1 Diabetes Mellitus (T1DM). The aim of this review is to provide insights into the epidemiology, pathophysiology, diagnostic issues, and treatment considerations of ICI-induced DM (ICI-DM), emphasizing the importance of early recognition and management to mitigate adverse outcomes. Although still rare, the incidence has increased with the widespread use of ICIs, especially PD-1/PD-L1 blockers (from 0.2% to 1.9%). Factors affecting the development of ICI-DM, such as specific ICIs, patient demographics, and genetic predispositions, are discussed. The complex interplay between immune dysregulation and pancreatic β-cell destruction contributes to diagnostic challenges, with presentations varying from asymptomatic hyperglycemia to diabetic ketoacidosis (DKA). Management strategies prioritize meticulous glycemic and electrolyte regulation along with tailored intravenous insulin therapy in cases of DKA. DM remission is rare, therefore treatment with both long-acting insulin at bedtime and short-acting insulin before meals is needed in longterm. Total daily insulin requirements can be estimated at 0.3–0.4 units/kg/day for most patients as a starting dose.

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Sapra, A., & Bhandari, P. (2024). Diabetes. In: StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK551501/

Title: Pathophysiology, diagnosis, and management of immune checkpoint inhibitor-induced diabetes mellitus
Authors: Eleni-Rafaela Kani
Eleftheria Karaviti
Dimitra Karaviti
Eleni Gerontiti
Ioanna A. Paschou
Katerina Saltiki
Katerina Stefanaki
Theodora Psaltopoulou
Stavroula A. Paschou
Publication date: 24-09-2024
Publisher: Springer US
Keywords: Checkpoint Inhibitors
Diabetes
Insulins
Insulins
Ketoacidosis
Hyperglycemia
Published in: Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-024-04050-5

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