Table 2.
Disease characteristics of patients with PD-1 inhibitor-induced diabetes
| Disease characteristics | All cases (n=21) | New-onset insulin-dependent diabetes (n=12) | Worsening of type 2 diabetes (n=9) |
| N (%) or median (IQR) | |||
| Time from ICI initiation to diagnosis | |||
| Numberof ICI cycles | 4 (2–5.5) | 4 (2–5.8) | 4 (2.5–9) |
| Duration (months) | 4.8 (2–8.2) | 4.9 (2.2–8.1) | 3.9 (1.8–10.3) |
| Weight change (kg) from ICI initiation to diagnosis | −3.3 (–7.1 to +0.2) | −3.4 (–7.3 to -2.4) | 0.3 (-7.6 to +7.6) |
| RPG (mg/dL) at diagnosis | 460 (372–807.5) | 600 (429–971) | 308 (224.3–533.2) |
| FPG (mg/dL) at diagnosis | 285 (206.5–316) | 298 (212.8–331.5) | 230 (199–307.5) |
| HbA1c at diagnosis | 9.9 (8.7–11.1); | 9.7 (8.6–10.7); | 10 (8.8–11.6); |
| (%; mmol/mol) | 85 (72–98) | 83 (70–93) | 86 (73–103) |
| Diabetic ketoacidosis | 8 (38.1)* | 8 (66.7)* | 0 (0) |
| Low C-peptide level (reference 1.1–4.4 ng/mL) | 5/7 (71.4) | 5/6 (83.3) | 0/1 (0) |
| Pancreatic enzymes | |||
| Mildly elevated | 4/14 (28.6) | 1/7 (14.3) | 3/7 (42.8) |
| Moderate to severely elevated (>2 times upper limit of normal) | 4/14 (28.6) | 3/7 (42.8) | 1/7 (14.3) |
| Not elevated | 6/14 (42.8) | 3/7 (42.8) | 3/7 (42.8) |
| Antibody positivity | 5/7 (71.4) | 5/7 (71.4) | Not checked |
| GAD65 (reference ≤0.02 nmol/L) | 4/7 (57.1) | 4/7 (57.1) | |
| IAA (reference ≤0.02 nmol/L) | 2/6 (33.3) | 2/6 (33.3) | |
| IA-2 (reference ≤0.02 nmol/L) | 1/6 (16.7) | 1/6 (16.7) | |
| ZnT8 (reference <15 U/mL) | 0/4 (0) | 0/4 (0) | |
| Increased pancreas FDG uptake | 1/9 (11.1) | 1/5 (20) | 0/4 (0) |
| Other IRAE | 13 (61.9) | 6 (50) | 7 (77.8) |
| Thyroiditis | 9 (69.2) | 5 (41.7) | 4 (44.4) |
| Hypophysitis | 3 (23.1) | 2 (16.7) | 1 (11.1) |
| Dermatitis | 2 (15.4) | 1 (8.3) | 1 (11.1) |
| Ocular | 1 (7.7) | – | 1 (11.1) |
| Hepatitis | 1 (7.7) | – | 1 (11.1) |
| Arthritis | 1 (7.7) | 1 (8.3) | – |
| Diabetes therapy at latest follow-up visit | |||
| MDI±oral agent | 19 (90.5) | 11 (91.7) | 7 (77.8) |
| Basal insulin±oral agent | 1 (4.8) | 0 (0) | 2 (22.2) |
| Insulin pump | 1 (4.8) | 1 (8.3) | 0 (0) |
| Follow-up duration after ICI start (months) | 17.9 (10.4–28.3) | 12.9 (10.4–24.3) | 26 (14.8–30.7) |
| Follow-up duration after diagnosis (months) | 12.5 (5.3–20.7) | 9.7 (3.9–12.9) | 17.2 (9.7–23.7) |
| Deaths (all from cancer) | 4 (19) | 1 (8.3) | 3 (33.3) |
*n=1 had concomitant hyperglycemic hyperosmolar state.
FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; ICI, immune checkpoint inhibitor; PD-1, programmed cell death protein 1; RPG, random plasma glucose.