PDF(Pubmed)
Abstract：
Immune 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.
The 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.
34.8% (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 Twelve (52.2%) patients were withdrawn from ICI due to ICI-DM.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.
The 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.
The 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.
34.8% (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.
The 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.
摘要：
■免疫检查点抑制剂（ICIs）提高了生存率，并越来越多地用于癌症。然而,ICIs的使用可能受到免疫相关不良事件(irAE)的限制，如ICI诱导的糖尿病（ICI-DM）。本研究的目的是表征ICI-DM患者和现实世界对指南的依从性。
■本研究对2018年7月至2022年10月南京医科大学第一附属医院ICI-DM患者的电子病历进行回顾性分析。
■34.8%(8/23)的患者在每个治疗周期监测血糖。严格血糖监测组重度糖尿病酮症酸中毒(DKA)患者比例低于非严格血糖监测组(16.7%vs.55.6%,p=0.049)。78.3%（18/23）的高血糖患者首先去了非内分泌学家，但95.7%的患者随后被转诊至内分泌学家.20例患者进行了区分高血糖病因的测试，20％的患者谷氨酸脱羧酶抗体（GADA）阳性，55%，C肽<3.33pmol/L。观察到其他ICI引起的内分泌疾病的高筛查率，并且一半的ICI-DM患者发生其他内分泌腺irAE，最常见的是甲状腺炎。此外，5例患者出现非内分泌严重不良事件(SAE).12例（52.2%）患者因ICI-DM退出ICI。ICI-DM患者继续和中断组的肿瘤进展时间长于停药组（333.5±82.5天vs.183.1±62.4天，p=0.161）。根据指南，只有17.4％的ICI-DM患者得到了完全治疗。因此，本研究提出了一种筛查，诊断,和实际实践中ICI-DM的管理算法。
■本研究报告了单个研究所描述的最多ICI-DM病例，提供对现实世界ICI-DM管理指南依从性的洞察，并强调ICI-DM管理中的临床挑战。
■本研究对2018年7月至2022年10月南京医科大学第一附属医院ICI-DM患者的电子病历进行回顾性分析。
■34.8%(8/23)的患者在每个治疗周期监测血糖。严格血糖监测组重度糖尿病酮症酸中毒(DKA)患者比例低于非严格血糖监测组(16.7%vs.55.6%,p=0.049)。78.3%（18/23）的高血糖患者首先去了非内分泌学家，但95.7%的患者随后被转诊至内分泌学家.20例患者进行了区分高血糖病因的测试，20％的患者谷氨酸脱羧酶抗体（GADA）阳性，55%，C肽<3.33pmol/L。观察到其他ICI引起的内分泌疾病的高筛查率，并且一半的ICI-DM患者发生其他内分泌腺irAE，最常见的是甲状腺炎。此外，5例患者出现非内分泌严重不良事件(SAE).12例（52.2%）患者因ICI-DM退出ICI。ICI-DM患者继续和中断组的肿瘤进展时间长于停药组（333.5±82.5天vs.183.1±62.4天，p=0.161）。根据指南，只有17.4％的ICI-DM患者得到了完全治疗。因此，本研究提出了一种筛查，诊断,和实际实践中ICI-DM的管理算法。
■本研究报告了单个研究所描述的最多ICI-DM病例，提供对现实世界ICI-DM管理指南依从性的洞察，并强调ICI-DM管理中的临床挑战。
