Immune checkpoint inhibitor-associated diabetic ketoacidosis induced by cadonilimab: a case report and literature review

Immune checkpoint inhibitors (ICIs) significantly improve prognosis and survival outcomes in cancer patients by enhancing immune function, thereby providing new therapeutic hope for cancer patients. However, with the widespread clinical application of ICIs, an increasing number of immune-related adverse events (irAEs) have been reported. Immune checkpoint inhibitor-induced type 1diabetes mellitus (ICI-T1DM) is a rare but potentially life-threatening irAE, usually presenting as acute onset and easily progressing to diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS), which poses a serious threat to patients' safety. This study reports a case of DKA in an 81-year-old female patient diagnosed with cervical squamous cell carcinoma without history of diabetes mellitus, which developed after multiple cycles of Cadonilimab. The patient's blood glucose levels were effectively controlled via insulin therapy and fluid resuscitation, and a definitive diagnosis of ICI-T1DM was confirmed. Taking this case as a starting point, this article reviews the epidemiology, clinical characteristics, pathogenesis, and clinical management strategies of ICI-T1DM, aiming to enhance clinicians' awareness of ICI-T1DM, especially the endocrine toxicity of dual-target ICIs such as cadonilimab, and provide practical reference for ensuring the safety of ICI therapy in cancer patients.