{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T14:10:10Z","timestamp":1756131010760,"version":"3.44.0"},"reference-count":14,"publisher":"SMC Media","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.<\/jats:p>","DOI":"10.12890\/2021_002756","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T08:02:56Z","timestamp":1629100976000},"source":"Crossref","is-referenced-by-count":6,"title":["Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus"],"prefix":"10.12890","volume":"8","author":[{"given":"Ahmed Osman","family":"Saleh","sequence":"additional","affiliation":[{"name":"Clinical Fellow, Endocrinology and Diabetes, HMC, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruba","family":"Taha","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, National Center for Cancer Care and Research, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shehab Fareed A.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, National Center for Cancer Care and Research, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Qatar Metabolic Institute Hamad Medical Corporation, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"10.12890\/2021_002756_ref1","doi-asserted-by":"crossref","unstructured":"<li>Barroso-Sousa R, Barry WT, Garrido-Castro AC, Hodi FS, Min L, Krop IE, et al. 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GAD65 autoantibodies and its role as biomarker of Type 1 diabetes and Latent Autoimmune Diabetes in Adults (LADA). <em>Drugs Future<\/em> 2011;<strong>36<\/strong>(11):847.<\/li>","DOI":"10.1358\/dof.2011.36.11.1710754"},{"key":"10.12890\/2021_002756_ref8","doi-asserted-by":"crossref","unstructured":"<li>Higham CE, Olsson-Brown A, Carroll P, Cooksley T, Larkin J, Lorigan P, et al. Society for Endocrinology Endocrine Emergency Guidance: acute management of the endocrine complications of checkpoint inhibitor therapy. <em>Endocr Connect<\/em> 2018;<strong>7<\/strong>(7):G1\u00ac\u2013G7. <\/li>","DOI":"10.1530\/EC-18-0068"},{"key":"10.12890\/2021_002756_ref9","doi-asserted-by":"crossref","unstructured":"<li>Pu N, Lou W, Yu J. PD-1 immunotherapy in pancreatic cancer. <em>J Pancreatol<\/em> 2019;<strong>2<\/strong>(1):6\u201310. <\/li>","DOI":"10.1097\/JP9.0000000000000010"},{"key":"10.12890\/2021_002756_ref10","doi-asserted-by":"crossref","unstructured":"<li>Spiers L, Coupe N, Payne M. 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The programmed death-1 (PD-1) pathway regulates autoimmune diabetes in nonobese diabetic (NOD) mice.<em> J Exp Med<\/em> 2003;<strong>198<\/strong>(1):63\u201369.<\/li>","DOI":"10.1084\/jem.20022125"},{"key":"10.12890\/2021_002756_ref13","doi-asserted-by":"crossref","unstructured":"<li>Fujisawa R, Haseda F, Tsutsumi C, Hiromine Y, Noso S, Kawabata Y, et al. Low programmed cell death-1 (PD-1) expression in peripheral CD4+T cells in Japanese patients with autoimmune type 1 diabetes. <em>Clin Exp Immunol<\/em> 2015;<strong>180<\/strong>(3):452\u2013457. <\/li>","DOI":"10.1111\/cei.12603"},{"key":"10.12890\/2021_002756_ref14","doi-asserted-by":"crossref","unstructured":"<li>Hansen E, Sahasrabudhe D, Sievert L. A case report of insulin-dependent diabetes as immune-related toxicity of pembrolizumab: presentation, management and outcome. <em>Cancer Immunol Immunother<\/em> 2016;<strong>65<\/strong>:765\u2013767. <\/li>","DOI":"10.1007\/s00262-016-1835-4"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/2756\/2801","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/2756\/2802","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/2756\/2802","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T13:33:50Z","timestamp":1756128830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/2756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,13]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.12890\/2021_002756","relation":{"has-manifestation":[{"id-type":"other","id":"1-74-2756-g2801","asserted-by":"subject"},{"id-type":"other","id":"1-74-2756-g2802","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-74","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2021,8,13]]},"article-number":"13"}}