Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations
Immune checkpoint inhibitors (ICIs) have an expanding role in the management of numerous cancers. Hyperglycaemia is commonly seen in patients treated with ICIs. However, the differential diagnosis for hyperglycaemia is broad, and incorrect diagnosis can have serious consequences. Herein we review th...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-06-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/13/6/e011271.full |
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| author | Ngai Wah Cheung Georgina V Long Roderick Clifton-Bligh Yiting Huang Matteo S Carlino Alexander Maxwell Menzies Linda Wu Venessa Tsang Tim Tse Meredith Oatley Jenny Gunton |
| author_facet | Ngai Wah Cheung Georgina V Long Roderick Clifton-Bligh Yiting Huang Matteo S Carlino Alexander Maxwell Menzies Linda Wu Venessa Tsang Tim Tse Meredith Oatley Jenny Gunton |
| author_sort | Ngai Wah Cheung |
| collection | DOAJ |
| description | Immune checkpoint inhibitors (ICIs) have an expanding role in the management of numerous cancers. Hyperglycaemia is commonly seen in patients treated with ICIs. However, the differential diagnosis for hyperglycaemia is broad, and incorrect diagnosis can have serious consequences. Herein we review the available literature on causes of hyperglycaemia in ICI treated patients and expert guidelines on management and provide an updated synthesis of expert multidisciplinary recommendations. Our key recommendations are as follows: Intensity of screening for hyperglycaemia should be based on a patient’s risk level, including assessment of factors such as corticosteroid use, pre-existing diabetes, baseline HbA1c and fasting blood glucose levels (BGL). People with new onset hyperglycaemia should undergo initial assessment to determine severity and aetiology, including bedside capillary BGL, and formal bloods including lipase, C-peptide with matching glucose, electrolytes and renal function and in some cases type 1 diabetes autoantibodies. People with BGL >15mmol/L (or those receiving SGLT2 inhibitors with BGL >10mmol/L) should additionally have ketones measured. Patients with a high risk of diabetic ketoacidosis (BGL>15 mmol/L, ketones >2 mmol/L) and/or risk of hyperosmolar hyperglycaemic state (BGL persistently >20 mmol/L or reading ‘HI’) should be referred directly to hospital for emergency assessment and management. Further management of hyperglycaemia should be tailored to the underlying cause(s). |
| format | Article |
| id | doaj-art-df84bcd4f4364b7e8285139d95d92776 |
| institution | Kabale University |
| issn | 2051-1426 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj-art-df84bcd4f4364b7e8285139d95d927762025-08-20T03:45:45ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262025-06-0113610.1136/jitc-2024-011271Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendationsNgai Wah Cheung0Georgina V Long1Roderick Clifton-Bligh2Yiting Huang3Matteo S Carlino4Alexander Maxwell Menzies5Linda Wu6Venessa Tsang7Tim Tse8Meredith Oatley9Jenny Gunton10Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, AustraliaRoyal North Shore Hospital, St Leonards, New South Wales, AustraliaRoyal North Shore Hospital, St Leonards, New South Wales, AustraliaBlacktown Hospital, Blacktown, New South Wales, AustraliaWestmead Hospital, Westmead, New South Wales, AustraliaFaculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, AustraliaWestmead Institute for Medical Research, Westmead, New South Wales, AustraliaRoyal North Shore Hospital, St Leonards, New South Wales, AustraliaMQ Health General Practice, Faculty of Medical Science, Health and Human Sciences, Macquarie University, Sydney, New South Wales, AustraliaRoyal North Shore Hospital, St Leonards, New South Wales, AustraliaWestmead Institute for Medical Research, Westmead, New South Wales, AustraliaImmune checkpoint inhibitors (ICIs) have an expanding role in the management of numerous cancers. Hyperglycaemia is commonly seen in patients treated with ICIs. However, the differential diagnosis for hyperglycaemia is broad, and incorrect diagnosis can have serious consequences. Herein we review the available literature on causes of hyperglycaemia in ICI treated patients and expert guidelines on management and provide an updated synthesis of expert multidisciplinary recommendations. Our key recommendations are as follows: Intensity of screening for hyperglycaemia should be based on a patient’s risk level, including assessment of factors such as corticosteroid use, pre-existing diabetes, baseline HbA1c and fasting blood glucose levels (BGL). People with new onset hyperglycaemia should undergo initial assessment to determine severity and aetiology, including bedside capillary BGL, and formal bloods including lipase, C-peptide with matching glucose, electrolytes and renal function and in some cases type 1 diabetes autoantibodies. People with BGL >15mmol/L (or those receiving SGLT2 inhibitors with BGL >10mmol/L) should additionally have ketones measured. Patients with a high risk of diabetic ketoacidosis (BGL>15 mmol/L, ketones >2 mmol/L) and/or risk of hyperosmolar hyperglycaemic state (BGL persistently >20 mmol/L or reading ‘HI’) should be referred directly to hospital for emergency assessment and management. Further management of hyperglycaemia should be tailored to the underlying cause(s).https://jitc.bmj.com/content/13/6/e011271.full |
| spellingShingle | Ngai Wah Cheung Georgina V Long Roderick Clifton-Bligh Yiting Huang Matteo S Carlino Alexander Maxwell Menzies Linda Wu Venessa Tsang Tim Tse Meredith Oatley Jenny Gunton Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations Journal for ImmunoTherapy of Cancer |
| title | Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations |
| title_full | Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations |
| title_fullStr | Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations |
| title_full_unstemmed | Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations |
| title_short | Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations |
| title_sort | hyperglycemia in patients treated with immune checkpoint inhibitors key clinical challenges and multidisciplinary consensus recommendations |
| url | https://jitc.bmj.com/content/13/6/e011271.full |
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