Immune checkpoint inhibitors (CPI) are increasingly used to improve survival rates in cancer patients. CPI therapy has been associated with new onset diabetes due to immune-mediated damage of beta-cells, with many patients presenting with diabetic ketoacidosis (DKA). We used Emory University’s Clinical Data Warehouse to examine clinical characteristics and outcomes of adult patients with new onset diabetes and DKA after CPI therapy from 01/01/2014 to 08/01/19. Comparisons of covariates were made with analysis of variance, χ2 and Fisher’s exact tests; log-rank test was used to analyze survival.

A total of 2279 patients received CPIs during the study period. Of these, 1622 had no DM, 540 had a previous history of DM, and 117 patients (5.1%) developed new onset DM after CPI treatment. Pembrolizumab, Nivolumab and Ipilimumab were the most common CPIs associated with DM. A total of 13 patients developed DKA, on average at 140 days from CPI initiation. Compared to no-DM group, patients with new-onset DM and DKA had higher DM-related hospitalization (p<0.01), mortality (p=0.02), and reduced survival from CPI initiation, p=0.03.

In summary, incidence of new-onset DM is 5.1% and is associated with higher DM-related hospitalizations. DKA patients have reduced survival compared to no-DM after CPI treatment. Healthcare professionals caring for patients undergoing CPI therapy need to be aware of this potential complication.


S. Hafeez: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Xing: None. G.E. Umpierrez: None.

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