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Table 1 Clinical history and key laboratory findings

From: Nivolumab-induced autoimmune diabetes mellitus presenting as diabetic ketoacidosis in a patient with metastatic lung cancer


Primary Diagnosis

Medical History

History Family

Anti-PD1 Drug

Other chemo-toxins

Diabetes presentation

Random C-peptide and BG

Time After PD-1

Ab titers before nivolumab*

Ab titers after nivolumab





No history of DM


Carboplatin, pemetrexed

DKA, BG 739, HbA1C 7.1%, urine ketones >80 mg/dL

<0.1 ng/mL while BG 377 mg/dL

2 wks

+ GAD65 (> 250), + IA-2 (6.2), - IAA (< 0.4), + ZnT8 (64)

+ GAD65 (> 30)a, + IA-2 (6.1), + IAA (0.4), - ZnT8 (13)b

A30:01,30:02 (A30) D09:CTZ,09:CTZ (DR9)

  1. Diabetic autoantibodies to GAD65, IA-2, and Insulin Ab were performed at Quest Diagnostics, San Juan Capistrano. Normal GAD65 titers < 0.5 IU/mL, IA-2 Ab < 0.8 U/mL, IAA < 0.4U/mL, and ZnT8 Ab <15 U/mL
  2. *Diabetic autoantibody testing before treatment was performed using a stored frozen specimen obtained at time of lung cancer diagnosis, 8 months prior to Nivolumab treatment
  3. aQuest changed GAD65 assay type from RIA to ELISA between the time the before and after treatment specimens were processed
  4. bZnT8 Ab obtained 13 months after the onset of diabetes