Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1263
Peer-review started: April 15, 2021
First decision: July 6, 2021
Revised: July 8, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: February 6, 2022
Processing time: 283 Days and 16.9 Hours
With the widespread application of immune checkpoint inhibitor (ICI) therapy, the number of immune-related adverse effects (irAEs) has increased over the years. Autoimmune diabetes mellitus (DM) is a rare irAEs of ICIs and can be troublesome and life threatening.
We report a 78-year-old woman with no history of diabetes who presented with hyperglycemia up to 23.4 mmol/L (random blood glucose level) after 14 courses of sintilimab. Hemoglobin A1c was 8.2%, fasting insulin was 0.29 mIU/mL, and fasting C-peptide was decreased to a level with negative autoantibodies. Combing her medical history and laboratory examination, she was diagnosed with programmed cell death (PD)-1-inhibitor-induced, new-onset autoimmune DM. After controlling her blood glucose, she was treated with daily insulin by subcutaneous injection. She was allowed to continue anti-PD-1 therapy and she still obtained some therapeutic efficacy. We also reviewed some published cases (n = 36) of PD-1/PD-ligand 1 (PD-L1) inhibitor-induced DM. We also discuss potential pathogenic mechanisms, clinical features, prognostic markers (β cell antibodies, human leukocyte antigen type, PD-L1 Level) of this rare adverse effect.
It is important for all clinicians to be aware of DM as an irAEs of ICIs.
Core tip: We report a case of programmed cell death (PD)-1-inhibitor-induced autoimmune diabetes mellitus (DM) after treatment of small cell lung cancer, and reviewed some published cases (n = 36) of PD-1/PD-ligand 1 inhibitor-induced DM. Plasma glucose monitoring is significant for preventing the occurrence of diabetic ketoacidosis.