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. 2023 Jan 4:13:1084441.
doi: 10.3389/fendo.2022.1084441. eCollection 2022.

Combined diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 1 diabetes mellitus induced by immune checkpoint inhibitors: Underrecognized and underreported emergency in ICIs-DM

Wenjing Zhang  1 , Jiexiu Chen  1   2 , Juan Bi  1 , Nan Ding  1 , Xin Chen  3 , Zhuo Wang  1 , Yang Jiao  4
Affiliations

Combined diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 1 diabetes mellitus induced by immune checkpoint inhibitors: Underrecognized and underreported emergency in ICIs-DM

Wenjing Zhang et al. Front Endocrinol (Lausanne). .

Abstract

Background: Combined diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) secondary to immune checkpoint inhibitors (ICIs) is extremely rarely reported among ICIs- diabetes mellitus (DM) cases and is always ignored by physicians. This study aimed to conduct a systematic review to recognize better the rare adverse event of combined DKA-HHS associated with immune checkpoints.

Methods: A electronic search in Pubmed/Cochrane/Web of Science, complemented by manual searches in article references, was conducted to identify clinical features of ICIs-combined DKA-HHS.

Results: we identified 106 patients with ICIs- type 1 diabetes mellitus (T1DM) from 82 publications: 9 patients presented a coexistence of metabolic acidosis, severe hyperglycemia, and/or DKA; All patients were not diagnosed as combined DKA-HHS. Compared with ICIs-DKA patients, combined DKA-HHS cases were prone to higher hyperglycemia (1020 ± 102.5 vs 686.7 ± 252.6mg/dL). Moreover, acute kidney injury (87.5% vs 28.6%) and prior chemotherapy (66.7% vs 31.6%) showed higher occurrences with the onset of ICIs-HHS or combined DKA-HHS.B.

Conclusions: Combined DKA-HHS portends a poor diagnosis in patients with coexistence features of DKA and HHS, which healthcare professionals and patients should be aware of due to differences in treatment. Our observational retrospective case series shows that patients with more risk factors were more likely to develop combined DKA-HHS. We are the first to report this group of patients' clinical characteristics and outcomes.

Keywords: combined DKA-HHS; diabetes mellitus; hyperosmolar hyperglycemic state; immune checkpoint inhibitor; programmed cell death-1.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for the systematic review.
Figure 2
Figure 2
Comparison the influences of T1DM-associated autoantibodies (A) and HLA genotypes (B) on the onset of ICIs-DM.
Figure 3
Figure 3
Comparison the effects of T1DM-associated autoantibodies (A) and HLA genotypes (B) on the BG at the onset of ICIs-DM.
See this image and copyright information in PMC

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