Immune-Related Diabetes Grade calculator

Clinical inputs

• Fasting glucose (mg/dL)Accepted range: 20 to 1500
• Laboratory fasting upper limit (mg/dL)Accepted range: 70 to 160
• Ketosis
• Laboratory evidence of type 1 diabetes
• Symptoms
• Unable to perform activities of daily living
• Life-threatening consequences

Primary source

Brahmer JR et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. PMID: 29442540. Table 4, section 4.4 Diabetes. Grade 1: asymptomatic or mild symptoms; fasting glucose above the upper limit of normal, printed as 160 mg/dL and as 8.9 mmol/L; no ketosis and no laboratory evidence of type 1 diabetes. Grade 2: moderate symptoms, able to perform activities of daily living; fasting glucose above 160 to 250 mg/dL (above 8.9 to 13.9 mmol/L); ketosis or evidence of type 1 diabetes at any glucose. Grade 3: fasting glucose above 250 to 500 mg/dL (above 13.9 to 27.8 mmol/L). Grade 4: fasting glucose above 500 mg/dL (above 27.8 mmol/L). The combined grade 3 to 4 symptom row is severe symptoms, medically significant or life-threatening consequences, or inability to perform activities of daily living. A fasting value above 500 mg/dL is the only row that is printed as grade 4 alone, so life-threatening consequences without that glucose are returned as 3. Glucose at 160 mg/dL stays in grade 1 when it is above the laboratory upper limit. Glucose at 250 mg/dL stays in grade 2. Glucose at 500 mg/dL stays in grade 3. When more than one printed finding is present, the higher grade is returned. Management text from the table is not used. (2018)