Immune checkpoint inhibitors linked to new type 1 diabetes

Immune checkpoint inhibitors, used to treat cancer, can sometimes cause new-onset type 1 diabetes. Dr. Anne Peters discussed this issue and the importance of patient care in managing this condition. Immune checkpoint inhibitors help the body's immune system attack cancer. However, they can have serious side effects, including type 1 diabetes. This form of diabetes appears suddenly and usually does not have a "honeymoon period," meaning patients require immediate insulin treatment due to severe insulin deficiency. Type 1 diabetes linked to these treatments mostly occurs in patients receiving certain antibody therapies, like anti-PD-1 and anti–PD-L1. It can develop within months to a few years after starting treatment, often presenting as diabetic ketoacidosis (DKA). Reports suggest that the incidence of this diabetes can range from 0.2% to 8%, depending on the drug used. Preventing or predicting this type of diabetes is difficult. Routine tests for autoantibodies or family history are not helpful. Instead, monitoring blood glucose levels before and after treatment can be useful. Although some patients develop a form resembling type 2 diabetes over time, most experience a rapid onset of severe type 1 diabetes that requires lifelong insulin therapy. For managing this diabetes, Dr. Peters recommends a simple approach. Many patients adapt well to automated insulin delivery systems and continuous glucose monitoring. These tools can ease the burden of managing diabetes, especially for those already facing cancer treatments. Dr. Peters emphasizes the importance of helping patients maintain their quality of life while dealing with both diabetes and cancer. She acknowledges the difficulty of choosing between having type 1 diabetes or cancer, noting the priority should always be to treat the cancer effectively.