{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:43Z","timestamp":1784557003802,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T00:00:00Z","timestamp":1524787200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4,27]]},"abstract":"Summary<\/jats:title>\n We report a case of a 67-year-old man with type 2 diabetes presented with diabetic ketoacidosis, two weeks after his first dose of nivolumab therapy for non\u2013small-cell lung carcinoma. He was started on empagliflozin two days prior in the setting of hyperglycaemia after the initiation of nivolumab therapy. Laboratory evaluation revealed an undetectable C-peptide and a positive anti-glutamic acid decarboxylase (GAD) antibody. He was treated with intravenous fluids and insulin infusion and was subsequently transitioned to subcutaneous insulin and discharged home. He subsequently has developed likely autoimmune thyroiditis and autoimmune encephalitis.<\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n Glycemic surveillance in patients receiving immune checkpoint inhibitors is recommended.<\/jats:p>\n <\/jats:list-item>\n \n Early glycemic surveillance after commencement of anti-programmed cell death-1 (PD-1) inhibitors may be indicated in selected populations, including patients with underlying type 2 diabetes mellitus and positive anti-glutamic acid decarboxylase (GAD) antibody.<\/jats:p>\n <\/jats:list-item>\n \n Sodium-glucose co transporter-2 (SGLT2) inhibitors should be used with caution in patients on immunotherapy.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-18-0021","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T03:35:46Z","timestamp":1524800146000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":13,"title":["Rapid-onset diabetic ketoacidosis secondary to nivolumab therapy"],"prefix":"10.1530","volume":"2018","author":[{"given":"Senhong","family":"Lee","sequence":"first","affiliation":[{"name":"1Department of Endocrinology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Morgan","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Shah","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R","family":"Ebeling","sequence":"additional","affiliation":[{"name":"1Department of Endocrinology, Monash Health, Clayton, Victoria, Australia"},{"name":"2Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref11","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s00262-017-2033-8","article-title":"Autoimmune diabetes induced by PD-1 inhibitor \u2013 retrospective analysis and pathogenesis: a case report and literature review","volume":"66","year":"2017","journal-title":"Cancer Immunology, Immunotherapy"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s40425-017-0245-2","article-title":"Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic lung cancer","volume":"5","year":"2017","journal-title":"Journal for Immunotherapy of Cancer"},{"key":"ref121","first-page":"1","article-title":"Beta cell dysfunction and insulin resistance","volume":"4","year":"2013","journal-title":"Frontiers in Endocrinology"},{"key":"ref21","first-page":"1","article-title":"Precipitation of autoimmune diabetes with anti immunotherapy https org","journal-title":"Diabetes Care"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1056\/NEJMc1701990","article-title":"Risk of diabetic ketoacidosis after initiation of an SGLT2 inhibitor","volume":"376","journal-title":"New England Journal of Medicine"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"2300","DOI":"10.1056\/NEJMc1701990","article-title":"Risk of diabetic ketoacidosis after initiation of an SGLT2 inhibitor","volume":"376","journal-title":"New England Journal of Medicine"},{"key":"ref101","first-page":"1","article-title":"Association of serum anti - 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GAD antibody and HLA haplotypes with type diabetes mellitus triggered by nivolumab in patients with non - small cell lung cancer of https org","journal-title":"Journal Thoracic Oncology"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s00262-017-2033-8","article-title":"Autoimmune diabetes induced by PD-1 inhibitor \u2013 retrospective analysis and pathogenesis: a case report and literature review","volume":"66","year":"2017","journal-title":"Cancer Immunology, Immunotherapy"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jecr.2017.05.002","article-title":"Diabetic ketoacidosis after treatment with pembrolizumab","volume":"5","year":"2017","journal-title":"Journal of Clinical and Translational Endocrinology: Case Reports"},{"key":"ref51","first-page":"1","article-title":"Beta cell dysfunction and insulin resistance","volume":"4","year":"2013","journal-title":"Frontiers in Endocrinology"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2018\/1\/EDM18-0021.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2018\/1\/EDM18-0021.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:46:50Z","timestamp":1784555210000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,27]]},"references-count":14,"URL":"https:\/\/doi.org\/10.1530\/edm-18-0021","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,27]]}}}