In a brand new publication from Cardiovascular Improvements and Purposes, Sharen Lee and Gary Tse from Laboratory of Cardiovascular Physiology, Hong Kong, HKG, China, Second Hospital of Tianjin Medical College, Tianjin, China and Xiamen Cardiovascular Hospital, Xiamen, China think about a case of atezolizumab-induced autoimmune diabetes mellitus presenting with diabetic ketoacidosis.
Atezolizumab, an immune checkpoint inhibitor, is a humanized monoclonal, anti-programmed dying ligand 1 (PD-L1) antibody used for the remedy of metastatic urothelial carcinoma that has progressed after chemotherapy. PD-L1 inhibitors can induce kind 1 diabetes, and sufferers can current with diabetic ketoacidosis. Blood glucose ranges ought to be often monitored in sufferers who’re prescribed these medicines.
The authors describe a affected person with a identified historical past of urothelial carcinoma who introduced with diabetic ketoacidosis 6 weeks following his second cycle of atezolizumab. His serum lactate degree was barely elevated and his β-hydroxybutyrate degree was elevated. Excessive anion hole metabolic acidosis secondary to diabetic ketoacidosis was recognized.
Subsequent testing demonstrated hemoglobin A1c degree of 9.9%, positivity for antiglutamic acid decarboxylase antibody and suppressed C-peptide degree within the absence of detectable anti-islet antigen 2 (IA-2) or anti-insulin antibodies.
His preliminary administration included cessation of atezolizumab remedy, intravenous sodium chloride administration, and insulin pump infusion, after which metabolic acidosis step by step resolved. The insulin pump was subsequently switched to Protaphane at 18 models earlier than breakfast and eight models earlier than dinner, along with metformin at 1000 mg twice every day.
4 weeks later his medicine was modified to human isophane insulin plus impartial insulin. Linagliptin at 5 mg was added 1 month later. His hemoglobin A1c degree declined to eight.1% 1 12 months later.
Tse, G., et al. (2021) A Affected person with Atezolizumab-Induced Autoimmune Diabetes Mellitus Presenting with Diabetic Ketoacidosis. Cardiovascular Improvements and Purposes. doi.