e23330 Background: Immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1, and CTLA-4 pathways have significantly improved survival in multiple cancers but may trigger immune-related adverse events (irAEs). Autoimmune type 1 diabetes mellitus (T1DM) is a rare endocrine irAE with permanent insulin dependence. This study aimed to characterize the clinical profile, onset, and outcomes of ICI-induced T1DM across multiple oncology centers. Methods: We retrospectively reviewed adult patients who developed new-onset insulin-dependent diabetes following ICI therapy between January 2018 and August 2025 across three tertiary cancer centers. Diagnosis of ICI-induced T1DM required hyperglycemia with low or absent C-peptide and/or positive pancreatic autoantibodies. Data on demographics, cancer type, ICI class, time to onset, presentation, and outcomes were analyzed descriptively. Results: Among 3,254 patients treated with ICIs, 27 (0.83%) developed autoimmune T1DM. Median age was 62 years (range, 38–79), and 56% were male. Most cases followed PD-1 inhibitor therapy (78%). Median onset time was 9 weeks (range, 3–40) after treatment initiation. Diabetic ketoacidosis occurred in 70% of cases at presentation. Anti-GAD antibodies were positive in 46%, and mean C-peptide level was 0.10 ng/mL. All patients required lifelong insulin. ICI therapy was resumed in 41% after stabilization. No diabetes-related deaths occurred. Oncologic outcomes were comparable to the overall treated cohort. Conclusions: ICI-induced autoimmune T1DM is an uncommon but irreversible immune-related adverse event. Early glucose monitoring and patient education are essential for timely detection and prevention of ketoacidosis. Multidisciplinary coordination between oncology and endocrinology teams facilitates safe ICI continuation without compromising cancer outcomes.
Banerji et al. (Thu,) studied this question.
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