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Diabetology International
Published in: Diabetology International 1/2019

01-01-2019 | Original Article

Characteristics and clinical course of type 1 diabetes mellitus related to anti-programmed cell death-1 therapy

Authors: Megu Yamaguchi Baden, Akihisa Imagawa, Norio Abiru, Takuya Awata, Hiroshi Ikegami, Yasuko Uchigata, Yoichi Oikawa, Haruhiko Osawa, Hiroshi Kajio, Eiji Kawasaki, Yumiko Kawabata, Junji Kozawa, Akira Shimada, Kazuma Takahashi, Shoichiro Tanaka, Daisuke Chujo, Tomoyasu Fukui, Junnosuke Miura, Kazuki Yasuda, Hisafumi Yasuda, Tetsuro Kobayashi, Toshiaki Hanafusa, for the consultation of the Japan Diabetes Society Committee on Type 1 Diabetes Mellitus Research

Published in: Diabetology International | Issue 1/2019

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Abstract

Aims

We conducted a national survey to clarify the characteristics and clinical course of type 1 diabetes related to anti-programmed cell death-1 therapy.

Methods

We analyzed the detailed data of 22 patients that were collected using a Japan Diabetes Society survey and a literature database search.

Results

Among the 22 patients, 11 (50.0%) met the criteria for fulminant type 1 diabetes and 11 (50.0%) met the criteria for acute-onset type 1 diabetes. The average patient age was 63 years. The mean duration between the date of the first anti-PD-1 antibody injection and development of type 1 diabetes was 155 days and ranged from 13 to 504 days. Flu-like symptoms, abdominal symptoms, and drowsiness were observed in 27.8, 31.6, and 16.7% patients, respectively. Mean ± standard deviation or median (first quartile–third quartile) glucose levels, HbA1c levels, urinary C-peptide immunoreactivity levels, and fasting serum C-peptide immunoreactivity levels were 617 ± 248 mg/dl, 8.1 ± 1.3%, 4.1 (1.4–9.4) μg/day, and 0.46 (0.20–0.70) ng/ml, respectively. Seventeen of 20 patients (85.0%) developed ketosis, and 7 of 18 patients (38.9%) developed diabetic ketoacidosis. Ten of 19 patients (52.6%) showed at least one elevated pancreatic enzyme level at the onset and two of seven patients showed this elevation before diabetes onset. Only one of 21 patients was anti-glutamic acid decarboxylase antibody positive.

Conclusions

Anti-programmed cell death-1 antibody-related type 1 diabetes varies from typical fulminant type 1 diabetes to acute-onset type 1 diabetes. However, diabetic ketoacidosis was frequently observed at the onset of diabetes. An appropriate diagnosis and treatment should be provided to avoid life-threatening metabolic alterations.
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Metadata
Title
Characteristics and clinical course of type 1 diabetes mellitus related to anti-programmed cell death-1 therapy
Authors
Megu Yamaguchi Baden
Akihisa Imagawa
Norio Abiru
Takuya Awata
Hiroshi Ikegami
Yasuko Uchigata
Yoichi Oikawa
Haruhiko Osawa
Hiroshi Kajio
Eiji Kawasaki
Yumiko Kawabata
Junji Kozawa
Akira Shimada
Kazuma Takahashi
Shoichiro Tanaka
Daisuke Chujo
Tomoyasu Fukui
Junnosuke Miura
Kazuki Yasuda
Hisafumi Yasuda
Tetsuro Kobayashi
Toshiaki Hanafusa
for the consultation of the Japan Diabetes Society Committee on Type 1 Diabetes Mellitus Research
Publication date
01-01-2019
Publisher
Springer Japan
Published in
Diabetology International / Issue 1/2019
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI
https://doi.org/10.1007/s13340-018-0362-2

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