Immune checkpoint inhibitors (ICI) have been emerged as a promising option for cancer treatments. However, ICI use induces immune-related adverse events including diabetes mellitus. We investigated the risk of new-onset diabetes in patients receiving ICI compared with conventional chemotherapy (CC) . Using a tertiary care hospital database, we included cancer patients without previous history of diabetes and treated with either CC or ICI. One-to-five nearest neighbor propensity matching was applied, and the risk for diabetes was estimated using a Cox proportional hazards model. Latent class growth modeling was performed in a trajectory approach to determine distinct clusters following a similar glucose trajectory pattern over time. Of 1,326 subjects, 1,1received CC, and 221 received ICI. The ICI group had a significantly higher cumulative incidence of diabetes compared with those in the CC group (log-rank p < 0.001) . In addition, the risk of new-onset diabetes was significantly increased in the ICI group compared to the CC group (adjusted hazard ratio 2.454, 95% confidence interval 1.528-3.940; p < 0.001) . The proportion of subjects in the trajectory cluster with an increasing glucose pattern was higher in the ICI group than in the CC group (10.4% for the ICI group and 7.4% for the CC group) . Among the ICI group, subjects with an increasing glucose pattern were predominantly male and associated with enhanced lymphocytosis after ICI administration.

In conclusion, ICI therapy is associated with an increased risk of incident diabetes compared with CC. Glucose levels in the subjects treated with ICI need to be regularly monitored for earlier detection of ICI-associated diabetes, especially males and those with prominent lymphocytosis after ICI treatment.


K.Jeong: None. M.Lee: None. Y.Park: None. Y.Rhee: None.


Grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) , funded by the Ministry of Health & Welfare, Republic of Korea. (grant number: HI19C0189) , and the Bio & Medical Technology Development Program of the National Research Foundation (NRF) , funded by the Korean government (MSIT) (NRF2019M3E5D4064682) .

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