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
- 1Department of Pharmacy, Quanzhou Traditional Chinese Medicine Hospital, Quanzhou, China
- 2Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
- 3Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China.
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.
Patient 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.
Diagnosis:: 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.
Intervention:: Intravenous insulin was transitioned to subcutaneous insulin in all patients, in addition to receiving fluid resuscitation and corrective electrolyte therapy.
Outcomes:: 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.
Lessons:: 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.
Related
- Sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis in an adolescent with type 2 diabetes.
- Euglycemic SGLT2 Inhibitor-Associated Ketoacidosis in a Nondiabetic Patient: A Case Report.
- Favorable CGM metrics do not exclude SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis: an educational case report with narrative review of literature
- Ketoacidosis at Hypoglycemic and Low Glucose Levels Associated with SGLT2 Inhibitor Use: A Descriptive Systematic Review of Published Cases
- Diabetic Ketoacidosis at Diagnosis is Associated With Adverse Long-Term Glycaemic Trajectories and Retinopathy in Adult-Onset Type 1 Diabetes. A Single-Centre Retrospective Cohort Study.
BibTeX
@article{mao2026rapidonset,
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}},
author = {Huihui Mao and Xuehui Jiang and Xiaowei Huang and Jingwen Fang and Yanling Mao and Lei Hong},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051420},
url = {https://europepmc.org/article/PMC/PMC13727197},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Huihui Mao
AU - Xuehui Jiang
AU - Xiaowei Huang
AU - Jingwen Fang
AU - Yanling Mao
AU - Lei Hong
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051420
UR - https://europepmc.org/article/PMC/PMC13727197
AB - 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. Patient 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. Diagnosis:: 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. Intervention:: Intravenous insulin was transitioned to subcutaneous insulin in all patients, in addition to receiving fluid resuscitation and corrective electrolyte therapy. Outcomes:: 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. Lessons:: 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.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -