Table 2

Disease characteristics of patients with PD-1 inhibitor-induced diabetes

Disease characteristicsAll 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 cycles4 (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 diagnosis460 (372–807.5)600 (429–971)308 (224.3–533.2)
FPG (mg/dL) at diagnosis285 (206.5–316)298 (212.8–331.5)230 (199–307.5)
HbA1c at diagnosis9.9 (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 ketoacidosis8 (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 elevated4/14 (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 elevated6/14 (42.8)3/7 (42.8)3/7 (42.8)
Antibody positivity5/7 (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 uptake1/9 (11.1)1/5 (20)0/4 (0)
Other IRAE13 (61.9)6 (50)7 (77.8)
 Thyroiditis9 (69.2)5 (41.7)4 (44.4)
 Hypophysitis3 (23.1)2 (16.7)1 (11.1)
 Dermatitis2 (15.4)1 (8.3)1 (11.1)
 Ocular1 (7.7)1 (11.1)
 Hepatitis1 (7.7)1 (11.1)
 Arthritis1 (7.7)1 (8.3)
Diabetes therapy at latest follow-up visit
 MDI±oral agent19 (90.5)11 (91.7)7 (77.8)
 Basal insulin±oral agent1 (4.8)0 (0)2 (22.2)
 Insulin pump1 (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.