From the Guidelines
Type 1 diabetes that develops in patients with pancreatic neuroendocrine tumors following immunotherapy treatment is typically permanent, even after immunotherapy is discontinued. This form of diabetes, often called immunotherapy-induced diabetes, occurs when checkpoint inhibitors trigger an autoimmune attack against pancreatic beta cells, destroying their ability to produce insulin 1. The destruction of beta cells is generally irreversible, requiring patients to remain on insulin therapy for life. Management includes multiple daily insulin injections or insulin pump therapy, with typical regimens involving both basal insulin and mealtime insulin. Blood glucose monitoring is essential, with target ranges typically between 80-130 mg/dL before meals and below 180 mg/dL after meals.
The permanence of this condition stems from the mechanism of action of immunotherapies, which remove the brakes on the immune system. Once beta cells are destroyed, the pancreas cannot regenerate them sufficiently, leading to permanent insulin deficiency. This differs from type 2 diabetes, which may be reversible with lifestyle changes or weight loss. According to the American Diabetes Association, pancreas transplantation can improve the quality of life of people with diabetes by eliminating acute complications, but it requires lifelong immunosuppression and has significant morbidity and mortality risks 1.
Key points to consider in managing type 1 diabetes in this context include:
- The importance of close blood glucose monitoring and adjusting insulin regimens as needed
- The potential for other autoimmune disorders to co-occur with type 1 diabetes
- The role of pancreas transplantation as a potential treatment option for select patients with severe complications or poor quality of life
- The need for lifelong immunosuppression and careful management of transplant patients to prevent rejection and recurrence of autoimmune destruction of pancreatic islet cells.
From the Research
Type 1 Diabetes and Immunotherapy
- Type 1 diabetes is an autoimmune disease that results from the immune-mediated destruction of insulin-producing β cells in the pancreas 2.
- Immunotherapy has been explored as a potential treatment option for type 1 diabetes, with the goal of halting disease progression and preserving β cell function 3, 2.
Reversibility of Type 1 Diabetes
- Studies have shown that immunosuppressive drugs can increase the rate and duration of remissions in patients with newly diagnosed type 1 diabetes, but the effect often vanishes after drug withdrawal 3, 4.
- This suggests that type 1 diabetes may not be completely reversible, even with immunotherapy, and that ongoing treatment may be necessary to maintain any beneficial effects.
Pancreatic Neuroendocrine Tumors and Type 1 Diabetes
- Pancreatic neuroendocrine tumors (PanNETs) can affect glucose metabolism and increase the risk of developing diabetes mellitus, including type 1 diabetes 5.
- However, there is limited evidence on the specific relationship between PanNETs, immunotherapy, and the reversibility of type 1 diabetes.
Current Understanding and Future Directions
- While immunotherapy holds promise as a treatment option for type 1 diabetes, more research is needed to fully understand its potential benefits and limitations 3, 2.
- Further studies are required to determine whether type 1 diabetes can be reversed or managed with immunotherapy, particularly in patients with PanNETs.