Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus
ObjectiveImmune checkpoint inhibitors(ICIs) have improved survival and are increasingly used for cancer. However, ICIs use may be limited by immune-related adverse events (irAEs), such as ICI-induced diabetes mellitus(ICI-DM). The objective of the present study was to characterize ICI-DM patients an...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1213225/full |
| _version_ | 1797773401717211136 |
|---|---|
| author | Min Shen Doudou Chen Ruiling Zhao Xuqin Zheng Yong Gu Tao Yang Yun Shi |
| author_facet | Min Shen Doudou Chen Ruiling Zhao Xuqin Zheng Yong Gu Tao Yang Yun Shi |
| author_sort | Min Shen |
| collection | DOAJ |
| description | ObjectiveImmune checkpoint inhibitors(ICIs) have improved survival and are increasingly used for cancer. However, ICIs use may be limited by immune-related adverse events (irAEs), such as ICI-induced diabetes mellitus(ICI-DM). The objective of the present study was to characterize ICI-DM patients and real-world adherence to guidelines.Research design and methodsThe present study was a retrospective review of electronic records of ICI-DM patients at the First Affiliated Hospital of Nanjing Medical University between July 2018 and October 2022.Results34.8% (8/23)patients monitored blood glucose in every treatment cycle. The proportion of patients with severe diabetic ketoacidosis(DKA) was lower in the tight glycemic monitoring group than the non-tight glycemic monitoring group (16.7% vs. 55.6%, p = 0.049). 78.3%(18/23) patients with hyperglycemia visited a non-endocrinologist first, but 95.7% of patients were then referred to an endocrinologist. Twenty patients were tested for distinguishing the etiology of hyperglycemia and 20% patients with positive glutamic acid decarboxylase antibody(GADA), 55% with C-peptide <3.33pmol/L. High screening rates for other ICI-induced endocrinopathies were observed and half of the patients with ICI-DM developed other endocrine gland irAEs, with the most common being thyroiditis. Moreover, five patients developed non-endocrine serious adverse events(SAEs). Twelve (52.2%) patients were withdrawn from ICI due to ICI-DM. The time to progression of tumor in ICI-DM patients in the continue and interruption group was longer than in the withdrawal group (333.5 ± 82.5 days vs. 183.1 ± 62.4 days, p = 0.161). Only 17.4% of ICI-DM patients were completely managed according to guidelines. Thus, the present study proposed a screening, diagnosis, and management algorithm for ICI-DM in real-world practice.ConclusionThe present study reported the largest number of ICI-DM cases described in a single institute, providing insight into real-world ICI-DM management guideline adherence and highlighting the clinical challenges in ICI-DM management. |
| first_indexed | 2024-03-12T22:05:57Z |
| format | Article |
| id | doaj.art-4acc1933eb4b434287e5db02401f4a53 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-12T22:05:57Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-4acc1933eb4b434287e5db02401f4a532023-07-24T13:27:58ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-07-011410.3389/fendo.2023.12132251213225Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitusMin ShenDoudou ChenRuiling ZhaoXuqin ZhengYong GuTao YangYun ShiObjectiveImmune checkpoint inhibitors(ICIs) have improved survival and are increasingly used for cancer. However, ICIs use may be limited by immune-related adverse events (irAEs), such as ICI-induced diabetes mellitus(ICI-DM). The objective of the present study was to characterize ICI-DM patients and real-world adherence to guidelines.Research design and methodsThe present study was a retrospective review of electronic records of ICI-DM patients at the First Affiliated Hospital of Nanjing Medical University between July 2018 and October 2022.Results34.8% (8/23)patients monitored blood glucose in every treatment cycle. The proportion of patients with severe diabetic ketoacidosis(DKA) was lower in the tight glycemic monitoring group than the non-tight glycemic monitoring group (16.7% vs. 55.6%, p = 0.049). 78.3%(18/23) patients with hyperglycemia visited a non-endocrinologist first, but 95.7% of patients were then referred to an endocrinologist. Twenty patients were tested for distinguishing the etiology of hyperglycemia and 20% patients with positive glutamic acid decarboxylase antibody(GADA), 55% with C-peptide <3.33pmol/L. High screening rates for other ICI-induced endocrinopathies were observed and half of the patients with ICI-DM developed other endocrine gland irAEs, with the most common being thyroiditis. Moreover, five patients developed non-endocrine serious adverse events(SAEs). Twelve (52.2%) patients were withdrawn from ICI due to ICI-DM. The time to progression of tumor in ICI-DM patients in the continue and interruption group was longer than in the withdrawal group (333.5 ± 82.5 days vs. 183.1 ± 62.4 days, p = 0.161). Only 17.4% of ICI-DM patients were completely managed according to guidelines. Thus, the present study proposed a screening, diagnosis, and management algorithm for ICI-DM in real-world practice.ConclusionThe present study reported the largest number of ICI-DM cases described in a single institute, providing insight into real-world ICI-DM management guideline adherence and highlighting the clinical challenges in ICI-DM management.https://www.frontiersin.org/articles/10.3389/fendo.2023.1213225/fullimmune-related adverse eventsimmune checkpoint inhibitorstoxicity guideline adherencediabetes mellitusproposal |
| spellingShingle | Min Shen Doudou Chen Ruiling Zhao Xuqin Zheng Yong Gu Tao Yang Yun Shi Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus Frontiers in Endocrinology immune-related adverse events immune checkpoint inhibitors toxicity guideline adherence diabetes mellitus proposal |
| title | Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus |
| title_full | Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus |
| title_fullStr | Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus |
| title_full_unstemmed | Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus |
| title_short | Real-world adherence to toxicity management guidelines for immune checkpoint inhibitor-induced diabetes mellitus |
| title_sort | real world adherence to toxicity management guidelines for immune checkpoint inhibitor induced diabetes mellitus |
| topic | immune-related adverse events immune checkpoint inhibitors toxicity guideline adherence diabetes mellitus proposal |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1213225/full |
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