Pembrolizumab Treatment Linked to Rapid Onset Type 1 Diabetes Mellitus
A retrospective analysis of 43 cases has revealed that pembrolizumab, an immune checkpoint inhibitor, can induce type 1 diabetes mellitus (T1DM). This adverse event is characterized by rapid and often irreversible beta-cell failure, frequent diabetic ketoacidosis, and persistent insulin dependence. The median age of affected patients was 67 years, with 55.8% being male. The onset of T1DM occurred at a median of 15 weeks after pembrolizumab initiation, ranging from 3 to 104 weeks. The most common underlying malignancies were melanoma (34.9%) and lung cancer (23.3%), and notably, 83.3% of patients had no prior history of diabetes. Symptoms included fatigue (62.5%), polyuria, polydipsia, or thirst (57.5%), and nausea or vomiting (45.0%). Diabetic ketoacidosis was observed in 83.7% of cases, with a median blood glucose level of 558 mg/dL at presentation. All patients required insulin therapy, and 97.0% of those with follow-up data showed persistent insulin dependence or beta-cell deficiency. The study also fou...