Rare Case of New-Onset Autoimmune Diabetes Associated With Nivolumab Use
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
American Journal of Respiratory and Critical Care Medicine
Abstract
Type 1 diabetes mellitus (T1DM) affects around 1.4 million adults worldwide. It is an autoimmune condition that causes pancreatic beta-cell loss, leading to hyperglycemia, which is typically diagnosed before the age of thirteen and rarely in adulthood. Nivolumab, a monoclonal antibody against the programmed cell death-ligand 1 (PD-L1) receptor, is an immunotherapy agent used in malignant and resectable non-small cell lung cancer (NSCLC). While it is crucial in managing NSCLC, it can have serious side effects. We present a rare case of diabetic ketoacidosis (DKA) and new-onset type 1 diabetes in an 81-year-old female diabetes being treated with nivolumab immunotherapy. The patient has a past medical history of NSCLC being treated with taxol, carboplatin, and nivolumab who presented to the hospital with fatigue, altered mental status, and malaise. On admission, she was found to have a glucose of 927, pH of 6.99, beta-hydroxybutyrate of 11, and bicarb of less than 5. She was admitted to the intensive care unit for further management of DKA. Further diabetic work-up included elevated GAD-65, low c-peptide, elevated insulin autoantibodies, and low insulin antibodies, which confirm a diagnosis of type 1 diabetes. No other diabetes precipitating factors, other than Nivolumab, were found. The patient’s mentation improved with the treatment of IV insulin, IV hydration, and electrolyte replacement. She was continued on a basal-bolus insulin regimen with improved glucose levels. She was diagnosed with autoimmune diabetes secondary to nivolumab use. Autoimmune islet cell damage is the presumed mechanism for how insulin-requiring diabetes mellitus can develop following the administration of anti-PD-L1. This case highlights the importance of recognizing and monitoring the development of DKA and de novo autoimmune diabetes in patients using anti-PD-L1 therapy.
Volume
211
First Page
A7531
Last Page
A7531
Recommended Citation
Kenney C, Marchewka T, Heal K. Rare case of new-onset autoimmune diabetes associated with nivolumab use. Am J Respir Crit Care Med. 2025 May;211:A7531. doi:10.1164/ajrccm.2025.211.Abstracts.A7531
DOI
10.1164/ajrccm.2025.211.Abstracts.A7531
Comments
American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA