Immune checkpoint inhibitor therapy and risk of type 1 diabetes mellitus in metastatic cancer patients.

IF 3.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetology & Metabolic Syndrome Pub Date : 2025-10-03 DOI:10.1186/s13098-025-01940-0

Ming-Hsun Lin, Ren-Hua Ye, Hong-Jie Jhou, Hsin-Yu Chen, Li-Ting Kao, Tina Yi-Jin Hsieh, Yu-Han Chen, Andrea Yue-En Sun, Xiaoyi Zhang, Ming-Shen Dai, Ching-Liang Ho, Po-Huang Chen, Cho-Hao Lee

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引用次数: 0

Abstract

Aims: To assess the risk of new-onset type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA) in metastatic cancer patients treated with immune checkpoint inhibitors (ICIs) compared to those receiving non-ICI therapies.

Method: A retrospective cohort study using TriNetX global electronic health records (2014-2025) from multiple healthcare systems. Adult metastatic cancer patients initiating ICI or non-ICI therapy were included. Patients with preexisting diabetes within 6 months were excluded. After 1:1 propensity score matching, 25,463 patients remained in each group. Outcomes were identified by ICD-10 codes.

Results: Median follow-up was 764 days (ICI) vs. 692 days (non-ICI). ICI use was associated with a higher risk of T1DM (HR, 2.35; 95% CI, 1.81-3.04) and DKA (HR, 10.58; 95% CI, 4.21-26.59). Cumulative incidence analyses supported these findings, with ICIs showing higher risks of T1DM (0.75% vs. 0.32%; RR, 2.32 [95% CI, 1.79-3.00]) and DKA (0.20% vs. 0.04%; RR, 5.00 [95% CI, 2.54-9.86]). Subgroup analyses identified elevated baseline HbA1c (> 6.0%), male sex, white race, and dual checkpoint blockade as high-risk factors.

Conclusion: ICIs significantly increase the risk of T1DM and DKA. These findings highlight the need for vigilant glycemic monitoring in cancer patients treated with ICIs, especially within identified high-risk subgroups.

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免疫检查点抑制剂治疗和转移性癌症患者1型糖尿病的风险。

目的：评估接受免疫检查点抑制剂（ici）治疗的转移性癌症患者与接受非ici治疗的患者相比，新发1型糖尿病（T1DM）和糖尿病酮症酸中毒（DKA）的风险。方法：采用来自多个医疗保健系统的TriNetX全球电子健康记录（2014-2025）进行回顾性队列研究。接受ICI或非ICI治疗的成年转移性癌症患者也包括在内。排除6个月内已有糖尿病的患者。在1:1的倾向评分匹配后，每组保留25,463例患者。结果由ICD-10代码确定。结果：中位随访时间为764天（ICI） vs. 692天（非ICI）。使用ICI与T1DM （HR, 2.35; 95% CI, 1.81-3.04）和DKA （HR, 10.58; 95% CI, 4.21-26.59）的高风险相关。累积发生率分析支持这些发现，ICIs显示T1DM （0.75% vs. 0.32%； RR, 2.32 [95% CI, 1.79-3.00]）和DKA （0.20% vs. 0.04%； RR, 5.00 [95% CI, 2.54-9.86]）的风险更高。亚组分析确定基线HbA1c升高（bbb6.0 %）、男性、白种人和双检查点封锁是高危因素。结论：ICIs可显著增加T1DM和DKA的发生风险。这些发现强调了对接受ICIs治疗的癌症患者进行警惕血糖监测的必要性，特别是在确定的高风险亚组中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetology & Metabolic Syndrome ENDOCRINOLOGY & METABOLISM-

CiteScore

6.20

自引率

0.00%

发文量

170

审稿时长

7.5 months

期刊介绍： Diabetology & Metabolic Syndrome publishes articles on all aspects of the pathophysiology of diabetes and metabolic syndrome. By publishing original material exploring any area of laboratory, animal or clinical research into diabetes and metabolic syndrome, the journal offers a high-visibility forum for new insights and discussions into the issues of importance to the relevant community.