Checkpoint Inhibitor-Associated Autoimmune Diabetes Mellitus Is Characterized by C-peptide Loss and Pancreatic Atrophy
Authors' conclusion
Pronounced biochemical and radiologic changes occur during CIADM pathogenesis. Rapid loss of C-peptide is a distinct characteristic that can be used to aid diagnosis as autoantibodies are often negative.
Study context
- Population
- Consecutive patients with checkpoint inhibitor-associated autoimmune diabetes (CIADM); all had anti-PD-1 or anti-PD-L1 therapy36 CIADM
- Participants
- 36 / 7 / 13 / 11
- Exposure
- CIADM vs immune checkpoint inhibitor (ICI)-treated controls
- CIADMn = 36
- ICI-related pancreatitisn = 7reference
- Asymptomatic ICI-related lipase elevationn = 13reference
- ICI-treated controlsn = 11reference
- Outcome
- Clinical characteristics at presentation
- Follow-up
- Presentation
Methodological detailsretrospective medical record review, CT volumetry
- Retrospective medical record review
- CT volumetry
Main finding
As reported in the abstract
- Median time from ICI commencement to CIADM diagnosis
- 15 weeks
- Diabetic ketoacidosis (DKA) at presentation
- 25 (69%)
- Low C-peptide at presentation
- 27 (84%)
- Low C-peptide by 1 month
- 100%
- Traditional T1D autoantibodies positive
- 15/35 (43%)
- Lipase elevated at presentation
- 13/27 (48%)
Observational data: associations, not effects.
Further findings
Longitudinal lipase
- In 4 patients with longitudinal lipase testing, elevated levels peaked 1 month prior to CIADM diagnosis
Pancreatic volume (CT volumetry) · pretreatment to 6 months post-CIADM diagnosis
- Mean decline in pancreatic volume in CIADM
- 41%
- Pancreatic volume lower pre-ICI in CIADM vs controls
Original publication
Checkpoint Inhibitor-Associated Autoimmune Diabetes Mellitus Is Characterized by C-peptide Loss and Pancreatic Atrophy. J Clin Endocrinol Metab. Published 24 November 2023. doi:10.
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