Nivolumab-induced fulminant type 1 diabetes (T1D): the first Italian case report with long follow-up and flash glucose monitoring
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Nivolumab, an Immune Checkpoint Inhibitor (ICI) against programmed death-1 receptors expressed on T-lymphocytes, has been approved by the Food and Drug Administration (FDA) for the treatment of multiple cancers such as Non-squamous Cell Lung Cancer . There are some concerns on this class of ICIs about immune-related adverse events, including thyroid dysfunction, hypophysitis, adrenal insufficiency and autoimmune diabetes mellitus (DM) .
Fulminant DM is a clinical entity firstly described in Japan, mainly characterized by markedly rapid onset of hyperglycemia with ketoacidosis, near normal glycated hemoglobin (HbA1c) levels despite remarkable hyperglycemia. Peculiar genetic factors, including human leukocyte antigen genes, are associated with the development of this subtype of diabetes and this could be the reason of the more frequent presentation of these cases in Asian populations. The Japanese Diabetes association has provided criteria for the diagnosis of this form of DM .
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Conflict of interest
All authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from the patient.
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