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    Patent Pending

    Immune-Related Adverse Events for Endocrine Toxicities - Diabetes Mellitus

    Grades severity of hyperglycemia secondary to immune checkpoint inhibitor therapy.

    INSTRUCTIONS

    Use in adult patients with signs and symptoms of new or worsening hyperglycemia that developed while on treatment with immune checkpoint inhibitors.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with signs and symptoms of new or worsening hyperglycemia that developed while on treatment with immune checkpoint inhibitors including agents against PD-1 (i.e., pembrolizumab, nivolumab), PD-L1 (i.e., atezolizumab, avelumab, durvalumab), or CTLA-4 (i.e., ipilimumab).

    • Immune checkpoint inhibitor (ICPi) related diabetes mellitus should be suspected in patients with laboratory evidence or signs and symptoms of new or worsening hyperglycemia while on treatment with immune checkpoint inhibitors.

    • May occur at any time during immune checkpoint inhibitor treatment.

    • Type 2 diabetes mellitus is more frequent and presents with worsening glycemic control. Type 1 diabetes mellitus is rarely seen, frequently presents with diabetic ketoacidosis and could lead to life threatening consequences.

    • Distinguishing type 1 diabetes mellitus from type 2 diabetes mellitus is necessary.

    This tool aids in the decision to discontinue ICPi, further diagnostic work-up, and oral antidiabetic or insulin treatment initiation.

    Asymptomatic or mild symptoms; fasting glucose value >160 mg/dL (>8.9 mmol/L); no evidence of ketosis or laboratory evidence of T1DM
    Moderate symptoms, able to perform ADLs, fasting glucose value >160-250 mg/dL (>8.9-13.9 mmol/L), ketosis or evidence of T1DM at any glucose level
    Severe symptoms, medically significant or life-threatening consequences, unable to perform ADLs; fasting glucose level >250-500 mg/dL (>13.9-27.8 mmol/L)
    Severe symptoms, medically significant or life-threatening consequences, unable to perform ADLs; fasting glucose level >500 mg/dL (>27.8 mmol/L)

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Julie R. Brahmer

    About the Creator

    Julie R. Brahmer, MSc, MD, is the co-director of the upper aerodigestive department at Johns Hopkins Medicine in Baltimore, MD. She is also a professor of oncology at Johns Hopkins Medicine. Dr. Brahmer’s primary research is focused on treatment of lung cancer and mesothelioma.

    To view Dr. Julie R. Brahmer's publications, visit PubMed

    Are you Dr. Julie R. Brahmer? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Nazli Dizman, MD
    About the Creator
    Dr. Julie R. Brahmer
    Are you Dr. Julie R. Brahmer?
    Content Contributors
    • Nazli Dizman, MD