Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?

New onset hyperglycemia during ICPi therapy warrants careful review of potential risk factors for type 2 diabetes mellitus (T2DM) and close monitoring of symptoms and lab results to distinguish from the rare and typically more threatening checkpoint inhibitor-associated diabetes mellitus (CIADM). New symptoms, such as acute onset polyuria, polydipsia, weight loss, and lethargy warrant consideration of CIADM and rapid consultation with endocrinology for testing and management. Initial diagnostic testing when CIADM is suspected should include urine and/or serum ketones, anion gap on a metabolic panel, anti-GAD or anti-islet cell antibodies, and C-peptide levels. Once adequate control of CIADM occurs, it is appropriate to continue ICPi’s. In t...