Clinical characteristics and unique presentations of immune checkpoint inhibitor induced type 1 diabetes in Chinese patients from a single institution

Abstract

Abstract Immune checkpoint inhibitor-induced type 1 diabetes (ICI-T1D) is a rare immune-related adverse event (irAE) of immune checkpoint inhibitors (ICIs). This retrospective study aimed to characterize the clinical features and glucose patterns of ICI-T1D in Chinese individuals and compare them with those of traditional T1D. Between January 2019 and April 2024, 15 patients diagnosed with ICI-T1D were consecutively enrolled. Continuous glucose monitoring (CGM) data from 7 of these patients were compared with data from 14 traditional T1D patients, matched for age, sex, fasting C-peptide levels, and diabetes duration. Median time from ICI initiation to T1D onset was 16 weeks (IQR, 6–96). Notably, T1D developed in four participants at 144, 112, 108, and 96 weeks after PD-1 treatment, respectively. Three ICI-T1D had pre-existing type 2 diabetes (T2D). Moreover, two had concurrent hypothyroidism and adrenal insufficiency alongside ICI-T1D. CGM analysis suggested that ICI-T1D exhibited a higher overall coefficient of variation (CV) (36.3 ± 4.8% vs. 28.2 ± 6.5%; p = 0.009), a greater CV during the night (37.4 ± 8.4% vs. 23.4 ± 7.3%; p = 0.001), and an increased standard deviation (SD) during the night (3.3 ± 0.8 mmol/L vs. 2.1 ± 1.1 mmol/L; p = 0.017) compared to those with traditional T1D. The study highlighted diverse clinical presentations of ICI-T1D, including delayed onset and multiple endocrine organs dysfunctions after ICI treatment. Consequently, long-term glucose monitoring and early identification are crucial. Furthermore, the observed greater glucose variability in ICI-T1D emphasizes the critical importance of diabetes education and personalized insulin regimen.

Keywords

• Immune checkpoint inhibitors
• Immune-related adverse events
• Immunotherapy
• Type 1 diabetes
• Continuous glucose monitoring.