A study of isolated hyperglycemia (blood glucose ≥155 mg/dL) at 1-hour of oral glucose tolerance test (OGTT) in patients with β-transfusion dependent thalassemia (β-TDT) followed for 12 years 1-hour post-load plasma glucose (1-h OGTT) in β-thalassemia major

Main Article Content

Vincenzo De Sanctis
Ashraf Soliman
Ploutarchos Tzoulis
Shahina Daar
Gabriella Cinzia Pozzobon
Christos Kattamis

Keywords

β-transfusion dependent thalassemia, oral glucose tolerance test, 1-Hr plasma glucose. Prediabetes, diabetes.

Abstract

Objective: Subjects with normal glucose tolerance (NGT) but 1-hour post-load plasma glucose (1-h OGTT) ≥ 155 mg/dl (8.6 mmol/L; H-NGT) have an increased risk for developing Type 2 diabetes mellitus (T2DM), determining a new risk factor category with deeper metabolic impairment. The aim of this study was to evaluate the H-NGT as a diagnostic predictor of future dysglycemia in β-transfusion dependent thalassemia (β-TDT). Indices of insulin secretion and insulin sensitivity derived at baseline from OGTTs, were also reviewed. Study design and methods: OGTT and indices of insulin secretion and insulin sensitivity, derived at baseline during OGTT, in 17 β-TDT with H-NGT and 29 β-TDT with normal OGTT (NGT) and without H-NGT followed for 12 years were studied. Results: H-NGT was associated with decreased insulin sensitivity and progressive deterioration of glucose tolerance. At baseline, serum ferritin and serum alanine aminotransferase (ALT) levels were higher in patients with H-NGT compared to patients with NGT. A strong correlation was observed between ALT and 1-hour plasma glucose value during OGTT in the total group of 36 patients . Compliance to iron chelation therapy was poor in β-TDT patients with H-NGT. An inverse correlation was found between 1-hour plasma glucose value during OGTT and insulin secretion-sensitivity index-2 (ISSI-2) (r: -0.3298; p: 0.025), between ISSI-2 and ALT (r: -0.3262; p: 0.027), and between 1-hour plasma glucose value and ISSI-2 (r: -0.537; p: 0.005) in the whole group of β-TDT patients enrolled in our study. Conclusions: This retrospective study displayed that finding an isolated high 1-hour post-load glucose level (≥155 mg/dL; H-NGT) during the OGTT may serve as a simple biomarker to detect high-risk patients, with chronic liver disease and/or iron overload, who need periodic glycemic surveillance. Measuring the ISSI 2 represented another valuable predictive marker in the assessment of glycemia in these patients.


 

Downloads

Download data is not yet available.
Abstract 74 | PDF Downloads 44

References

1. Weatherall DJ. Thalassemia as a global health problem: recent progress toward its control in the developing countries. Ann N Y Acad Sci. 2010;1202:17-23.
2. Viprakasit V, Ekwattanakit S. Clinical Classification, Screening and Diagnosis for Thalassemia. Hematol Oncol Clin North Am. 2018;32:193-211.
3. Taher AT, Saliba AN. Iron overload in thalassemia: different organs at different rates. Hematology Am Soc Hematol Educ Program. 2017;1:265-271.
4. De Sanctis V, Soliman AT, Candini G, Elsedfy H. Hepatitis C virus infection in thalassemic patients with and without insulin dependent diabetes. Indian J Endocrinol Metab. 2015;19:303-304.
5. De Sanctis V, Soliman A, Yassin M. Iron overload and glucose metabolism in subjects with β-thalassaemia major: an overview. Curr Diabetes Rev. 2013; 9:332-541.
6. De Sanctis V, Soliman AT, Elsedfy H, et al. Diabetes and Glucose Metabolism in Thalassemia Major: An Update. Expert Rev Hematol. 2016;9:401-408.
7. Chern JP, Lin KH, Lu MY, et al. Abnormal glucose tolerance in transfusion-dependent beta-thalassemic patients. Diabetes Care. 2001;24:850-854.
8. Cario H, Holl RW, Debatin KM, Kohne E. Insulin sensitivity and beta-cell secretion in thalassaemia major with secondary haemochromatosis: assessment by oral glucose tolerance test. Eur J Pediatr. 2003;162:139-146.
9. De Sanctis V, Soliman AT, Elsedfy H, et al. The ICET-A Recommendations for the Diagnosis and Management of Disturbances of Glucose Homeostasis in Thalassemia Major Patients. Mediterr J Hematol Infect Dis. 2016 Oct 28;8(1):e2016058. doi: 10.4084/MJHID.2016.058.
10. De Sanctis V, Soliman AT, Elsedfy H, et al. Growth and endocrine disorders in thalassemia: The international network on endocrine complications in thalassemia (I-CET) position statement and guidelines. Indian J Endocrinol Metab. 2013;17:8-18.
11. Liang Y, Bajoria R, Jiang Y, et al. Prevalence of diabetes mellitus in Chinese children with thalassaemia major. Trop Med Int Health. 2017;22:716-724.
12. Pepe A, Pistoia L, Gamberini MR, et al. The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study. Diabetes Care. 2020; 43: 2830-2839.
13. Bergman M, Jagannathan R, Buysschaert M, et al. Lessons learned from the 1-hour post-load glucose level during OGTT: Current screening recommendations for dysglycaemia should be revised. Diabetes Metab Res Rev. 2018 Jul;34(5):e2992. doi: 10.1002/dmrr.2992.
14. Buysschaert M, Bergman M, Yanogo D, Jagannathan R, Buysschaert B, Preumont V. An elevated 1-h post- load glucose level during the oral glucose tolerance test detects prediabetes. Diabetes Metab Syndr. 2017;11:137-139.
15. Bergman M, Chetrit A, Roth J, Jagannathan R, Sevick M, Dankner R. One-hour post-load plasma glucose level during the OGTT predicts dysglycemia: Observations from the 24year follow-up of the Israel Study of Glucose Intolerance, Obesity and Hypertension. Diabetes Res Clin Pract. 2016;120:221-228.
16. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes - 2020. Diabetes Care. 2020; 43 (Suppl. 1): S14-S31.
17. De Sanctis V, Elsedfy H, Soliman AT, et al. Clinical and Biochemical Data of Adult Thalassemia Major patients (TM) with Multiple Endocrine Complications (MEC) versus TM Patients with Normal Endocrine Functions: A long-term Retrospective Study (40 years) in a Tertiary Care Center in Italy. Mediterr J Hematol Infect Dis. 2016 Apr 12;8(1):e2016022. doi: 10.4084/MJHID.2016.022.
18. Fulwood R, Johnson CL, Bryner JD. Hematological and nutritional biochemistry reference data for persons 6 months–74 years of age: United States, 1976–1980. National Center for Health Statistics, Vital Health Stat Series.1982; 11:1-173.
19. Matsuda M, De Fronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care.1999; 22:1462–1470.
20. Płaczkowska S, Pawlik-Sobecka L, Kokot I, Piwowar A. Estimation of reference intervals of insulin resistance (HOMA), insulin sensitivity (Matsuda), and insulin secretion sensitivity indices (ISSI-2) in Polish young people. Ann Agric Environ Med. 2020;27:248-254.
21. Retnakaran R, Qi Y, Goran MI, Hamilton JK. Evaluation of proposed oral disposition index measures in relation to the actual disposition index. Diabet Med. 2009;26:1198–203.
22. Kahn SE: The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of type 2 diabetes. Diabetologia,2003;46:3–19.
23. Alder R, Roesser EB. Introduction to probability and statistics.WH Freeman and Company Eds. Sixth Edition.San Francisco (USA), 1975 PMCid:PMC1674139.
24. Fiorelli G, Vullo C. Linee guida per la diagnosi ed il trattamento delle complicanze endocrine nel paziente talassemico. www.atdl.it dell’Associazione Talassemici e Drepanocitici Lombardi ONLUS, 1999.
25. Yip WCY, Sequeira IR, Plank LD, Poppitt SD. Prevalence of Pre-Diabetes across Ethnicities: A Review of Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) for Classification of Dysglycaemia. Nutrients. 2017 Nov 22;9(11):1273. doi: 10.3390/nu9111273.
26. Nguyen QM, Srinivasan SR, Xu JH, Chen W, Berenson GS. Fasting plasma glucose levels within the normoglycemic range in childhood as a predictor of prediabetes and type 2 diabetes in adulthood: the Bogalusa Heart Study. Arch Pediatr Adolesc Med. 2010;164:124-128.
27. Peddinti G, Bergman M, Tuomi T, Groop L. 1-Hour Post-OGTT Glucose Improves the Early Prediction of Type 2 Diabetes by Clinical and Metabolic Markers. J Clin Endocrinol Metab. 2019;104:1131-1140.
28. De Sanctis V, Soliman AT, Candini G, Elsedfy H. Hepatitis C virus infection in thalassemic patients with and without insulin dependent diabetes. Indian J Endocrinol Metab. 2015;19:303-304.
29. Lecube A, Hernández C, Genescà J, Esteban JI, Jardí R, Simó R. High prevalence of glucose abnormalities in patients with hepatitis C virus infection: a multivariate analysis considering the liver injury. Diabetes Care. 2004;27:1171-1175.
30. Retnakaran R, Shen S, Hanley AJ, Vuksan V, Hamilton JK, Zinman B. Hyperbolic relationship between insulin secretion and sensitivity on oral glucose tolerance test. Obesity (Silver Spring) 2008;16:1901–1907.
31. Karadas N, Yurekli B, Bayraktaroglu S, Aydinok Y. Insulin secretion-sensitivity index-2 could be a novel marker in the identification of the role of pancreatic iron deposition on beta-cell function in thalassemia major. Endocr J. 2019;66:1093-1099.
32. National Collaborating Centre for Primary Care: Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence. London: NICE; 2009.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 > >>