ToolsCalculators
Immune-Related Adverse Events for Endocrine Toxicities - Diabetes Mellitus
CTCAE-based severity grade for hyperglycemia/new-onset diabetes from checkpoint inhibitor therapy.
Immune-Related Adverse Events for Endocrine Toxicities - Diabetes Mellitus
Blood glucose (fasting or random)
Diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) present
Complete the fields above to see the result.
When to use
- Grading hyperglycemia or new-onset diabetes mellitus in patients on immune checkpoint inhibitor (ICPi) therapy, to guide continuation/hold decisions and endocrinology referral.
Formula
CTCAE v5.0 hyperglycemia grading applied to ICPi-related diabetes: Grade 1, glucose >ULN (~100 mg/dL)-160 mg/dL; Grade 2, >160-250 mg/dL; Grade 3, >250-500 mg/dL (hospitalization indicated); Grade 4, >500 mg/dL or DKA/HHS (life-threatening).
Pearls and pitfalls
- ICPi-associated diabetes often presents as fulminant, insulin-deficient (type 1-like) diabetes; check a C-peptide and islet autoantibodies and have a low threshold to check for DKA.
- Unlike most irAEs, ICPi-induced diabetes is usually irreversible and requires lifelong insulin even after checkpoint inhibitor discontinuation.