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<p>An 86-year-old woman with metastatic non-small cell lung carcinoma (NSCLC) on Pembrolizumab presented to the Emergency Department with diabetic ketoacidosis (DKA) and was subsequently transitioned to basal/bolus insulin regimen. At diagnosis, curative-intent radiation therapy was discussed but declined due to concerns regarding toxicity and quality of life; pembrolizumab was therefore initiated as palliative systemic therapy. The patient developed abrupt, insulin-deficient diabetes requiring lifelong insulin therapy, resulting in substantial deterioration in functional well-being with prominent anxiety and psychological distress. Emerging real-world data suggest that immune checkpoint inhibitor (ICI)–associated diabetes occurs more frequently than initially reported in early clinical trials. Beyond underscoring the importance of patient education regarding early symptoms of hyperglycemia, this case highlights the need for comprehensive pre-treatment counseling that addresses the potential permanence and psychological burden of chronic immune-related adverse events (irAE).</p>

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Psychological distress following immune checkpoint inhibitor associated diabetes: a case report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月25日

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  • Stephanie Saey,
  • Jas Sara,
  • Pankaj Shah

摘要

An 86-year-old woman with metastatic non-small cell lung carcinoma (NSCLC) on Pembrolizumab presented to the Emergency Department with diabetic ketoacidosis (DKA) and was subsequently transitioned to basal/bolus insulin regimen. At diagnosis, curative-intent radiation therapy was discussed but declined due to concerns regarding toxicity and quality of life; pembrolizumab was therefore initiated as palliative systemic therapy. The patient developed abrupt, insulin-deficient diabetes requiring lifelong insulin therapy, resulting in substantial deterioration in functional well-being with prominent anxiety and psychological distress. Emerging real-world data suggest that immune checkpoint inhibitor (ICI)–associated diabetes occurs more frequently than initially reported in early clinical trials. Beyond underscoring the importance of patient education regarding early symptoms of hyperglycemia, this case highlights the need for comprehensive pre-treatment counseling that addresses the potential permanence and psychological burden of chronic immune-related adverse events (irAE).