{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T04:55:56Z","timestamp":1793422556629,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2025,5,15]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>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\u2019s 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 &gt;15mmol\/L (or those receiving SGLT2 inhibitors with BGL &gt;10mmol\/L) should additionally have ketones measured. Patients with a high risk of diabetic ketoacidosis (BGL&gt;15 mmol\/L, ketones &gt;2 mmol\/L) and\/or risk of hyperosmolar hyperglycaemic state (BGL persistently &gt;20 mmol\/L or reading \u2018HI\u2019) should be referred directly to hospital for emergency assessment and management. Further management of hyperglycaemia should be tailored to the underlying cause(s).<\/jats:p>","DOI":"10.1136\/jitc-2024-011271","type":"journal-article","created":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T16:05:26Z","timestamp":1749398726000},"page":"e011271","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Hyperglycemia in patients treated with immune checkpoint inhibitors: key clinical challenges and multidisciplinary consensus recommendations"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8699-6341","authenticated-orcid":false,"given":"Linda","family":"Wu","sequence":"first","affiliation":[{"name":"Westmead Institute for Medical Research, Westmead, New South Wales, Australia"},{"name":"Westmead Hospital, Westmead, New South Wales, Australia"},{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venessa","family":"Tsang","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick","family":"Clifton-Bligh","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo S","family":"Carlino","sequence":"additional","affiliation":[{"name":"Westmead Hospital, Westmead, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"},{"name":"Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia"},{"name":"Mater Hospital, North Sydney, New South Wales, Australia"},{"name":"Blacktown Hospital, Blacktown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Tse","sequence":"additional","affiliation":[{"name":"MQ Health General Practice, Faculty of Medical Science, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiting","family":"Huang","sequence":"additional","affiliation":[{"name":"Blacktown Hospital, Blacktown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Oatley","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngai Wah","family":"Cheung","sequence":"additional","affiliation":[{"name":"Westmead Hospital, Westmead, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina V","family":"Long","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"},{"name":"Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia"},{"name":"Mater Hospital, North Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5183-7562","authenticated-orcid":false,"given":"Alexander Maxwell","family":"Menzies","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"},{"name":"Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia"},{"name":"Mater Hospital, North Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Gunton","sequence":"additional","affiliation":[{"name":"Westmead Institute for Medical Research, Westmead, New South Wales, Australia"},{"name":"Westmead Hospital, Westmead, New South Wales, Australia"},{"name":"Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"key":"2026052722354394000_13.6.e011271.1","doi-asserted-by":"publisher","DOI":"10.1080\/2162402X.2020.1824645"},{"key":"2026052722354394000_13.6.e011271.2","doi-asserted-by":"crossref","DOI":"10.1111\/dme.15053","article-title":"Hyperglycaemia following immune checkpoint inhibitor therapy-Incidence, aetiology and assessment","volume":"40","author":"Mulla","year":"2023","journal-title":"Diabet Med"},{"key":"2026052722354394000_13.6.e011271.3","doi-asserted-by":"crossref","first-page":"108633","DOI":"10.1016\/j.diabres.2020.108633","article-title":"Characterization of hyperglycemia in patients receiving immune checkpoint inhibitors: Beyond autoimmune insulin-dependent diabetes","volume":"172","author":"Leiter","year":"2021","journal-title":"Diabetes Res Clin Pract"},{"key":"2026052722354394000_13.6.e011271.4","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.3389\/fphar.2019.01453","article-title":"Incidence of Immune Checkpoint Inhibitor-Associated Diabetes: A Meta-Analysis of Randomized Controlled Studies","volume":"10","author":"Lu","year":"2019","journal-title":"Front Pharmacol"},{"key":"2026052722354394000_13.6.e011271.5","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1001\/jamaoncol.2018.1684","article-title":"Incidence of Diabetes After Cancer Development","volume":"4","author":"Hwangbo","year":"2018","journal-title":"JAMA Oncol"},{"key":"2026052722354394000_13.6.e011271.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2021.100218"},{"key":"2026052722354394000_13.6.e011271.7","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22777"},{"key":"2026052722354394000_13.6.e011271.8","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i2.249"},{"key":"2026052722354394000_13.6.e011271.9","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/732027"},{"key":"2026052722354394000_13.6.e011271.10","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00423"},{"key":"2026052722354394000_13.6.e011271.11","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-0609"},{"key":"2026052722354394000_13.6.e011271.12","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1465"},{"key":"2026052722354394000_13.6.e011271.13","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-19-0291"},{"key":"2026052722354394000_13.6.e011271.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2018-000591","article-title":"Immune checkpoint inhibitors: an emerging cause of insulin-dependent diabetes","volume":"7","author":"Kotwal","year":"2019","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2026052722354394000_13.6.e011271.15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1001\/jamaoncol.2017.3064","article-title":"Incidence of Endocrine Dysfunction Following the Use of Different Immune Checkpoint Inhibitor Regimens: A Systematic Review and Meta-analysis","volume":"4","author":"Barroso-Sousa","year":"2018","journal-title":"JAMA Oncol"},{"key":"2026052722354394000_13.6.e011271.16","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-02221"},{"key":"2026052722354394000_13.6.e011271.17","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-2535"},{"key":"2026052722354394000_13.6.e011271.18","doi-asserted-by":"crossref","unstructured":"Liu Y , Zhang H , Zhou L , et al . Immunotherapy-Associated Pancreatic Adverse Events: Current Understanding of Their Mechanism, Diagnosis, and Management. Front Oncol 2021;11. doi:10.3389\/fonc.2021.627612","DOI":"10.3389\/fonc.2021.627612"},{"key":"2026052722354394000_13.6.e011271.19","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-022-00683-6"},{"key":"2026052722354394000_13.6.e011271.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2012.12.023"},{"key":"2026052722354394000_13.6.e011271.21","doi-asserted-by":"crossref","first-page":"110151","DOI":"10.1016\/j.diabres.2022.110151","article-title":"Dexamethasone-induced hyperglycaemia in COVID-19: Glycaemic profile in patients without diabetes and factors associated with hyperglycaemia","volume":"194","author":"Rhou","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"2026052722354394000_13.6.e011271.22","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.12090"},{"key":"2026052722354394000_13.6.e011271.23","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1111\/dme.13675","article-title":"Management of hyperglycaemia and steroid (glucocorticoid) therapy: a guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care group","volume":"35","author":"Roberts","year":"2018","journal-title":"Diabet Med"},{"key":"2026052722354394000_13.6.e011271.24","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i8.1073"},{"key":"2026052722354394000_13.6.e011271.25","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-0653"},{"key":"2026052722354394000_13.6.e011271.26","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1007\/s13300-018-0468-3","article-title":"Glycemic Control in Hospitalized Patients with Diabetes Receiving Corticosteroids Using a Neutral Protamine Hagedorn Insulin Protocol: A Randomized Clinical Trial","volume":"9","author":"Khowaja","year":"2018","journal-title":"Diabetes Ther"},{"key":"2026052722354394000_13.6.e011271.27","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1002\/phar.2616","article-title":"Insulin NPH for steroid-induced hyperglycemia: Predictors for success","volume":"41","author":"Stone","year":"2021","journal-title":"Pharmacotherapy"},{"key":"2026052722354394000_13.6.e011271.28","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.diabres.2015.09.015","article-title":"Randomized clinical trial of the efficacy and safety of insulin glargine vs. NPH insulin as basal insulin for the treatment of glucocorticoid induced hyperglycemia using continuous glucose monitoring in hospitalized patients with type 2 diabetes and respiratory disease","volume":"110","author":"Ruiz de Adana","year":"2015","journal-title":"Diabetes Res Clin Pract"},{"key":"2026052722354394000_13.6.e011271.29","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1111\/dom.12859","article-title":"Treatment of prednisolone-induced hyperglycaemia in hospitalized patients: Insights from a randomized, controlled study","volume":"19","author":"Radhakutty","year":"2017","journal-title":"Diabetes Obes Metab"},{"key":"2026052722354394000_13.6.e011271.30","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-2098"},{"key":"2026052722354394000_13.6.e011271.31","doi-asserted-by":"crossref","first-page":"110557","DOI":"10.1016\/j.diabres.2023.110557","article-title":"Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia","volume":"197","author":"Chen","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"2026052722354394000_13.6.e011271.32","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S009"},{"key":"2026052722354394000_13.6.e011271.33","doi-asserted-by":"crossref","first-page":"650","DOI":"10.5694\/mja14.01187","article-title":"A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society","volume":"201","author":"Gunton","year":"2014","journal-title":"Med J Aust"},{"key":"2026052722354394000_13.6.e011271.34","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-2202"},{"key":"2026052722354394000_13.6.e011271.35","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1210\/clinem\/dgad685","article-title":"Checkpoint Inhibitor-Associated Autoimmune Diabetes Mellitus Is Characterized by C-peptide Loss and Pancreatic Atrophy","volume":"109","author":"Wu","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"2026052722354394000_13.6.e011271.36","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14168"},{"key":"2026052722354394000_13.6.e011271.37","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00059.2006"},{"key":"2026052722354394000_13.6.e011271.38","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01440"},{"key":"2026052722354394000_13.6.e011271.39","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2021-002435","article-title":"Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events","volume":"9","author":"Brahmer","year":"2021","journal-title":"J Immunother Cancer"},{"key":"2026052722354394000_13.6.e011271.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.10.001"}],"container-title":["Journal for ImmunoTherapy of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jitc-2024-011271","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T05:36:08Z","timestamp":1779946568000},"score":1,"resource":{"primary":{"URL":"https:\/\/jitc.bmj.com\/lookup\/doi\/10.1136\/jitc-2024-011271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,8]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/jitc-2024-011271"],"URL":"https:\/\/doi.org\/10.1136\/jitc-2024-011271","relation":{},"ISSN":["2051-1426"],"issn-type":[{"value":"2051-1426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}