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Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review
Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of various types of cancers worldwide. Although ICI-related autoimmune diabetes is a rare complication, it can be associated with a life-threatening condition, diabetic ketoacidosis (DKA). Here, we report the cases of four pa...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997462/ https://www.ncbi.nlm.nih.gov/pubmed/32047478 http://dx.doi.org/10.3389/fendo.2020.00014 |
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author | Hong, A Ram Yoon, Jee Hee Kim, Hee Kyung Kang, Ho-Cheol |
author_facet | Hong, A Ram Yoon, Jee Hee Kim, Hee Kyung Kang, Ho-Cheol |
author_sort | Hong, A Ram |
collection | PubMed |
description | Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of various types of cancers worldwide. Although ICI-related autoimmune diabetes is a rare complication, it can be associated with a life-threatening condition, diabetic ketoacidosis (DKA). Here, we report the cases of four patients who presented with ICI-induced DKA in a tertiary center in Korea. Three patients were newly diagnosed with type 1 diabetes, and one patient was known to have a history of type 2 diabetes. All DKA cases were due to programmed cell death protein-1 (PD-1) or its ligand inhibitors (PD-L1). The mean age of the patients was 71.5 years, and the mean time for diagnosing the onset of DKA after starting ICIs was 15.8 weeks. Glutamic acid decarboxylase antibodies were positive in one patient (25%) who already had been treated with type 2 diabetes. All four patients showed improved antitumor responses after ICI therapy and are currently receiving insulin treatment for glycemic control, regardless of their continuation of ICIs. As there have been no practically available predictive biomarkers for the diagnosis of DKA or type 1 diabetes thus far, close monitoring of blood glucose levels is required in all patients receiving ICIs. |
format | Online Article Text |
id | pubmed-6997462 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-69974622020-02-11 Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review Hong, A Ram Yoon, Jee Hee Kim, Hee Kyung Kang, Ho-Cheol Front Endocrinol (Lausanne) Endocrinology Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of various types of cancers worldwide. Although ICI-related autoimmune diabetes is a rare complication, it can be associated with a life-threatening condition, diabetic ketoacidosis (DKA). Here, we report the cases of four patients who presented with ICI-induced DKA in a tertiary center in Korea. Three patients were newly diagnosed with type 1 diabetes, and one patient was known to have a history of type 2 diabetes. All DKA cases were due to programmed cell death protein-1 (PD-1) or its ligand inhibitors (PD-L1). The mean age of the patients was 71.5 years, and the mean time for diagnosing the onset of DKA after starting ICIs was 15.8 weeks. Glutamic acid decarboxylase antibodies were positive in one patient (25%) who already had been treated with type 2 diabetes. All four patients showed improved antitumor responses after ICI therapy and are currently receiving insulin treatment for glycemic control, regardless of their continuation of ICIs. As there have been no practically available predictive biomarkers for the diagnosis of DKA or type 1 diabetes thus far, close monitoring of blood glucose levels is required in all patients receiving ICIs. Frontiers Media S.A. 2020-01-28 /pmc/articles/PMC6997462/ /pubmed/32047478 http://dx.doi.org/10.3389/fendo.2020.00014 Text en Copyright © 2020 Hong, Yoon, Kim and Kang. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Hong, A Ram Yoon, Jee Hee Kim, Hee Kyung Kang, Ho-Cheol Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review |
title | Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review |
title_full | Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review |
title_fullStr | Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review |
title_full_unstemmed | Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review |
title_short | Immune Checkpoint Inhibitor-Induced Diabetic Ketoacidosis: A Report of Four Cases and Literature Review |
title_sort | immune checkpoint inhibitor-induced diabetic ketoacidosis: a report of four cases and literature review |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997462/ https://www.ncbi.nlm.nih.gov/pubmed/32047478 http://dx.doi.org/10.3389/fendo.2020.00014 |
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