Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus
Abstract Background Immune checkpoint inhibitors (ICI) are promising treatment options for various cancers. However, their use is associated with immune-related adverse events (irAEs), including ICI-induced diabetes mellitus (ICI-DM). This study aimed to investigate the clinical features of ICI-DM,...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Diabetology & Metabolic Syndrome |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13098-024-01263-6 |
| _version_ | 1797276377409388544 |
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| author | Hung-Hui Wei Ying-Chieh Lai Gigin Lin Cheng-Wei Lin Ya-Chu Chang John Wen-Cheng Chang Miaw-Jene Liou I-Wen Chen |
| author_facet | Hung-Hui Wei Ying-Chieh Lai Gigin Lin Cheng-Wei Lin Ya-Chu Chang John Wen-Cheng Chang Miaw-Jene Liou I-Wen Chen |
| author_sort | Hung-Hui Wei |
| collection | DOAJ |
| description | Abstract Background Immune checkpoint inhibitors (ICI) are promising treatment options for various cancers. However, their use is associated with immune-related adverse events (irAEs), including ICI-induced diabetes mellitus (ICI-DM). This study aimed to investigate the clinical features of ICI-DM, with a particular focus on alterations to pancreatic volume. Methods We conducted a retrospective review of 2829 patients who received ICI treatment at the Chang Gung Memorial Hospital, Linkou, between January 2014 and December 2021. New-onset diabetes or diabetic ketoacidosis (DKA) was identified in ten patients receiving ICI therapy. Pancreatic volumes were assessed by manual segmentation of computed tomography (CT) images before and after ICI-DM diagnosis. Results Among these ten patients, nivolumab was the most commonly used ICI (50.0%), followed by pembrolizumab (30.0%) and atezolizumab (20.0%). One patient received combination therapy with nivolumab and ipilimumab. The median age was 63.01 years (range: 40.1 − 87.8). ICI-DM developed after a median of 13.5 cycles (range: 2 − 42) of ICI treatment or 9.85 months (range:1.5 − 21.3) since ICI initiation. The initial presentation was DKA in 60.0% of patients. All patients had low or undetectable C-peptide levels (range: <0.033 − 0.133 nmol/L) and were negative for most type 1 diabetes mellitus (T1DM)-related autoantibodies; only one patient tested positive for glutamic acid decarboxylase antibodies. CT imaging revealed significant pancreatic atrophy, with a median pancreatic volume decrease of 19.92% (P = 0.038) from baseline and sustained significant decline at last follow-up (median − 37.14%, P = 0.012). Conclusions ICI-DM is often accompanied by pancreatic atrophy and approximately two-thirds of patients initially present with DKA. Although the majority of ICI-DM patients lack T1DM-related autoantibodies, identifying diminished pancreatic volumes through CT imaging provides valuable clues into the subclinical aspects of ICI-DM development, aiding in the prevention of diabetic emergencies. Trial registration Not applicable. |
| first_indexed | 2024-03-07T15:27:25Z |
| format | Article |
| id | doaj.art-0c74cd8ef065457ab3824351707e78d0 |
| institution | Directory Open Access Journal |
| issn | 1758-5996 |
| language | English |
| last_indexed | 2024-03-07T15:27:25Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj.art-0c74cd8ef065457ab3824351707e78d02024-03-05T16:36:58ZengBMCDiabetology & Metabolic Syndrome1758-59962024-01-0116111010.1186/s13098-024-01263-6Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitusHung-Hui Wei0Ying-Chieh Lai1Gigin Lin2Cheng-Wei Lin3Ya-Chu Chang4John Wen-Cheng Chang5Miaw-Jene Liou6I-Wen Chen7Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at LinkouDepartment of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouDepartment of Medical Imaging and Intervention, Chang Gung Memorial Hospital at LinkouDivision of Endocrinology and Metabolism, Chang Gung Memorial Hospital at LinkouDivision of Endocrinology and Metabolism, Chang Gung Memorial Hospital at LinkouDivision of Hematology-Oncology, Chang Gung Memorial Hospital at LinkouDivision of Endocrinology and Metabolism, Chang Gung Memorial Hospital at LinkouDivision of Endocrinology and Metabolism, Chang Gung Memorial Hospital at LinkouAbstract Background Immune checkpoint inhibitors (ICI) are promising treatment options for various cancers. However, their use is associated with immune-related adverse events (irAEs), including ICI-induced diabetes mellitus (ICI-DM). This study aimed to investigate the clinical features of ICI-DM, with a particular focus on alterations to pancreatic volume. Methods We conducted a retrospective review of 2829 patients who received ICI treatment at the Chang Gung Memorial Hospital, Linkou, between January 2014 and December 2021. New-onset diabetes or diabetic ketoacidosis (DKA) was identified in ten patients receiving ICI therapy. Pancreatic volumes were assessed by manual segmentation of computed tomography (CT) images before and after ICI-DM diagnosis. Results Among these ten patients, nivolumab was the most commonly used ICI (50.0%), followed by pembrolizumab (30.0%) and atezolizumab (20.0%). One patient received combination therapy with nivolumab and ipilimumab. The median age was 63.01 years (range: 40.1 − 87.8). ICI-DM developed after a median of 13.5 cycles (range: 2 − 42) of ICI treatment or 9.85 months (range:1.5 − 21.3) since ICI initiation. The initial presentation was DKA in 60.0% of patients. All patients had low or undetectable C-peptide levels (range: <0.033 − 0.133 nmol/L) and were negative for most type 1 diabetes mellitus (T1DM)-related autoantibodies; only one patient tested positive for glutamic acid decarboxylase antibodies. CT imaging revealed significant pancreatic atrophy, with a median pancreatic volume decrease of 19.92% (P = 0.038) from baseline and sustained significant decline at last follow-up (median − 37.14%, P = 0.012). Conclusions ICI-DM is often accompanied by pancreatic atrophy and approximately two-thirds of patients initially present with DKA. Although the majority of ICI-DM patients lack T1DM-related autoantibodies, identifying diminished pancreatic volumes through CT imaging provides valuable clues into the subclinical aspects of ICI-DM development, aiding in the prevention of diabetic emergencies. Trial registration Not applicable.https://doi.org/10.1186/s13098-024-01263-6Immune check point inhibitorsAutoimmunityDiabetes mellitusInsulin-dependent-diabetesPancreatic volume |
| spellingShingle | Hung-Hui Wei Ying-Chieh Lai Gigin Lin Cheng-Wei Lin Ya-Chu Chang John Wen-Cheng Chang Miaw-Jene Liou I-Wen Chen Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus Diabetology & Metabolic Syndrome Immune check point inhibitors Autoimmunity Diabetes mellitus Insulin-dependent-diabetes Pancreatic volume |
| title | Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus |
| title_full | Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus |
| title_fullStr | Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus |
| title_full_unstemmed | Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus |
| title_short | Distinct changes to pancreatic volume rather than pancreatic autoantibody positivity: insights into immune checkpoint inhibitors induced diabetes mellitus |
| title_sort | distinct changes to pancreatic volume rather than pancreatic autoantibody positivity insights into immune checkpoint inhibitors induced diabetes mellitus |
| topic | Immune check point inhibitors Autoimmunity Diabetes mellitus Insulin-dependent-diabetes Pancreatic volume |
| url | https://doi.org/10.1186/s13098-024-01263-6 |
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