Sintilimab treatment induces Type 1 Diabetes in 69-year-old cancer patient, requiring insulin therapy

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, but they can trigger immune-related adverse events (irAEs). Among these, Type 1 diabetes mellitus (T1DM) is a rare but severe complication, characterized by autoimmune destruction of pancreatic β cells. This leads to irreversible insulin deficiency. Unlike other irAEs, ICI-induced T1DM often responds poorly to steroid treatment, necessitating prompt and specific management. Understanding the incidence, pathogenesis, and optimal management strategies for this specific irAE remains a critical clinical gap.

This article reports a single case of a 69-year-old patient diagnosed with poorly differentiated adenocarcinoma of the stomach and colon. The patient received treatment with Sintilimab combined with the SOX regimen (a chemotherapy combination). The study's focus was to document the development of T1DM during this treatment and review existing literature on ICI-induced T1DM. Blood glucose levels were monitored throughout the treatment course to identify any onset of diabetes.

During treatment with Sintilimab and the SOX regimen, the 69-year-old patient developed Type 1 diabetes mellitus. This adverse event necessitated immediate medical intervention. Following the diagnosis, the patient was initiated on insulin treatment. > After insulin treatment, her blood glucose levels gradually stabilized, indicating effective management of the induced diabetes. The authors also conducted a literature analysis, which explored the pathogenesis of ICI-induced T1DM, highlighting diagnostic difficulties due to its often rapid onset and atypical presentation. The review emphasized that current treatment primarily centers around insulin replacement therapy, given the poor efficacy of steroids in reversing β-cell damage.