In:
Diabetes, American Diabetes Association, Vol. 69, No. Supplement_1 ( 2020-06-01)
Abstract:
Immune checkpoint inhibitors (ICIs) treat cancer by augmenting patients’ (pts) immune responses against cancer. The immune activation from ICIs is associated with immune-related adverse events. Inflammation has a known association with hyperglycemia (HG) and insulin resistance. Little is known about the prevalence of post-ICI HG (pIHG) beyond autoimmune diabetes (DM). We hypothesized that: (1)Pts with pIHG are more likely to have steroid exposure, pre-existing DM, and obesity (body mass index ≥30kg/m2); (2)A subset of pts have pIHG that cannot be explained by autoimmune DM or steroid use. We analyzed a cohort of 411 cancer pts on ICIs between 2011 and 2017 at our institution. We included pts who had ≥3 post-ICI glucose measurements. We defined pIHG as a random glucose & gt;200mg/dL from ICI initiation up to 6 months after cessation. We recorded DM diagnosis and steroid exposure as documented in the medical record. We compared pts with and without pIHG using the Fisher’s exact test. 385 pts had post-ICI glucose data. 105 (27.3%) had pIHG. Compared to those without pIHG, pIHG pts were more likely to be male (71% vs. 59%, p=0.04), to have pre-existing DM (54% vs. 10%, p & lt;0.01) and to be obese (31% vs. 18%, p & lt;0.01). Of the 105 pts with pIHG, 59(56%) had pre-ICI HG, 9(8.6%) had no pre-ICI glucose data, and 37(35.2%) had new onset pIHG. Of these 37 pts, 25(67.6%) had steroid-related HG and none had antibody-confirmed autoimmune DM. Of the remaining 12 pts, 3 had worsening of pre-existing DM. No obvious precipitant of HG was detected in the remaining 9 pts apart from ICI therapy. Timing of HG after ICI initiation ranged from 4 to 107 weeks (median 12.3 weeks). HG in 5 of these pts resolved without intervention. In conclusion, pIHG occurred in over a quarter of pts. Risk factors for pIHG included pre-existing DM and obesity. The majority of new pIHG was related to steroid use. However, a subset of pts had new HG that may be related to ICI therapy, suggesting that ICIs may have a role in immune-related insulin resistance. Disclosure A. Leiter: None. E. Carroll: None. D.C. Brooks: None. J. Ben Shimol: None. E. Eisenberg: None. M. Galsky: Advisory Panel; Self; AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., Merck & Co., Inc., Pfizer Inc. E. Gallagher: Advisory Panel; Self; Novartis Pharmaceuticals Corporation. Funding National Cancer Institute (P30CA196521, K08CA190770)
Type of Medium:
Online Resource
ISSN:
0012-1797
,
1939-327X
Language:
English
Publisher:
American Diabetes Association
Publication Date:
2020
detail.hit.zdb_id:
1501252-9
