1138-P: Diabetes Induced by Immunotherapy

Abstract

Introduction: Immunotherapy in the field of oncology consists of administering substances that stimulate the immune system involved in its recognition and destruction of the tumor, on the other hand it gives side effects including diabetes. Observation: After 29 injections of Pembrolizumab to treat his pulmonary adenocarcinoma, a 62-years old man was hospitalized with inaugural diabetic ketoacidosis with plasma glucose 5.47g and pH 7.07 in blood gas. The dosage of the C peptide is low, the antibodies specific for autoimmune diabetes were negatives at the time of diagnosis. HLA DR3/DQ2 study reveals a predisposition to autoimmune type 1 diabetes. Basal-bolus insulin therapy was started with a correct balance of diabetes. Discussion: Diabetes induced by anti-PD1 immunotherapy is more common in patients older than 50 years and shown between one month and nineteen months after starting treatment. The reason for hospitalization is always diabetic ketoacidosis with very high plasma blood glucose levels and deep insulinopenia. The HLA studying of patients shown a predisposition to autoimmune diabetes. Conclusion: The management of diabetes induced by immunotherapy requires consultation between the endocrinologist and the oncologist. Patient education with the initial assessment diabetes are essential before and during treatment with immunotherapy. An initial assessment (the fasting blood glucose, HbA1c) routinely before starting anti-PD1 therapy and determination of fasting blood glucose before each course of treatment, once a month during the first three months then every three months or urgently if clinical signs are present suggestive of diabetes. In addition, insulin therapy should start immediately in case of diagnosis is made. Disclosure D. Vy: None.