Characteristics and Clinical Course of Type 1 Diabetes Mellitus Related to Anti-programmed Cell Death-1 Therapy

Abstract

We conducted a national survey to clarify the characteristics and clinical course of type 1 diabetes related to anti-programmed cell death-1 therapy. We analyzed the detailed data of 22 patients that were collected using a Japan Diabetes Society survey and a literature database search. Among the 22 patients, 11 (50.0 %) met the criteria for fulminant type 1 diabetes and 11 (50.0 %) met the criteria for acute onset type 1 diabetes. The average patient age was 63 years. The mean duration between the date of the first anti-PD-1 antibody injection and development of type 1 diabetes was 155 days and ranged from 13 to 504 days. Flu-like symptoms, abdominal symptoms, and drowsiness were observed in 27.8 %, 31.6 %, and 16.7 % patients, respectively. Mean±standard deviation or median (first quartile-third quartile) glucose levels, HbA1c levels, urinary C-peptide immunoreactivity levels, and fasting serum C-peptide immunoreactivity levels were 617±248 mg/dL, 8.1±1.3 %, 4.1 (1.4-9.4) μg/day, and 0.46 (0.20-0.70) ng/mL, respectively. Seventeen of 20 patients (85.0 %) developed ketosis, and seven of 18 patients (38.9 %) developed diabetic ketoacidosis. Ten of 19 patients (52.6 %) showed at least one elevated pancreatic enzyme level at the onset and two of seven patients showed this elevation before diabetes onset. Only one of 21 patients was anti-glutamic acid decarboxylase antibody positive. In conclusion, anti-programmed cell death-1 antibody-related type 1 diabetes varies from typical fulminant type 1 diabetes to acute onset type 1 diabetes. However, diabetic ketoacidosis was frequently observed at the onset of diabetes. An appropriate diagnosis and treatment should be provided to avoid life-threatening metabolic alterations.