{
  "abstract": "Rationale:: Immune checkpoint inhibitors (ICIs), including those targeting the programmed cell death 1 (PD-1) receptor, its ligand (PD-L1), and cytotoxic T lymphocyte antigen 4 (CTLA-4), are widely used in treating various cancers. Although generally well-tolerated, ICIs can cause severe immune-related adverse events (irAEs), including endocrine toxicities like hypophysitis, thyroid dysfunction, and adrenal insufficiency. Among these, ICI-induced type 1 diabetes mellitus (T1DM) is a rare but life-threatening irAE.\n\nPatient concerns:: In order to provide a more comprehensive understanding of this condition, we describe 4 cases of PD-1 inhibitor-induced T1DM in Chinese patients.\n\nDiagnosis:: All 4 patients developed diabetic ketoacidosis (DKA) within 1 week of hyperglycemic symptom onset, and 3 were diagnosed with fulminant T1DM. All patients were male, with a mean age of 63 years. The median time from PD-1 inhibitor initiation (sintilimab or camrelizumab) to T1DM diagnosis was 112 days. At onset, the mean blood glucose level was 684 mg/dL, mean glycated hemoglobin (HbA1c) was 8.22%, and mean serum C-peptide level was 0.13 ng/ml.\n\nIntervention:: Intravenous insulin was transitioned to subcutaneous insulin in all patients, in addition to receiving fluid resuscitation and corrective electrolyte therapy.\n\nOutcomes:: All patients eventually discontinued PD-1 inhibitor therapy. Through insulin treatment, their hyperglycemia was effectively controlled. Additionally, all our patients achieved stable disease or partial response in tumor treatment evaluation at T1DM onset.\n\nLessons:: These cases highlight that anti-PD-1 therapy can trigger a rapid and severe form of T1DM. All cancer patients receiving PD-1 inhibitors should undergo close monitoring of blood glucose levels and receive patient education.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pharmacy, Quanzhou Traditional Chinese Medicine Hospital, Quanzhou, China",
    "Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China",
    "Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Huihui Mao"
    },
    {
      "affs": [
        1
      ],
      "name": "Xuehui Jiang"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaowei Huang"
    },
    {
      "affs": [
        2
      ],
      "name": "Jingwen Fang"
    },
    {
      "affs": [
        2
      ],
      "name": "Yanling Mao"
    },
    {
      "affs": [
        1
      ],
      "name": "Lei Hong",
      "orcid": "0009-0006-1453-4793"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/afn783jdek50t.bib",
  "cited_by": 0,
  "doi": "10.1097/md.0000000000051420",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727197/?tool=EBI",
  "id": "afn783jdek50t",
  "issns": [
    "0304-5412",
    "1536-5964",
    "0025-7974"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13727197",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "4300"
    ],
    [
      "heading",
      "Clinical Case Report"
    ],
    [
      "heading",
      "Research Article"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727197/pdf/?tool=EBI",
  "pmcid": "PMC13727197",
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/afn783jdek50t.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13727197",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13727197"
    },
    {
      "first_seen": "2026-11-05T12:23:20Z",
      "native_id": "PMC13727197",
      "source": "pmc",
      "url": "https://doi.org/10.1097/md.0000000000051420"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Rapid-onset type 1 diabetes mellitus and diabetic ketoacidosis : A case series of programmed cell death 1 inhibitor-associated endocrine toxicity in China : Four case reports",
  "title_text": "Rapid-onset type 1 diabetes mellitus and diabetic ketoacidosis : A case series of programmed cell death 1 inhibitor-associated endocrine toxicity in China : Four case reports",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:55Z",
  "url": "https://research.draconitic.com/paper/afn783jdek50t",
  "venue": "Medicine",
  "versions": []
}