The use of oral glucose-lowering agents (GLAs) in β-thalassemia patients with diabetes: Preliminary data from a retrospective study of ICET-A Network: Oral glucose-lowering agents (GLAs) in β-thalassemia patients

Vincenzo De Sanctis; Ashraf  Soliman; Ploutarchos  Tzoulis; Shahina  Daar; Antonis   Kattamis; Polyxeni  Delaporta; Mehran  Karimi; Mohamed A. Yassin; Tahereh Zarei; Forough Saki; Katia Sapunarova; Atanas Banchev; Maria Concetta Galati; Giuseppe Raiola; Giuseppe Messina; Saveria  Campisi; Christos Kattamis

doi:10.23750/abm.v93i2.12056

The use of oral glucose-lowering agents (GLAs) in β-thalassemia patients with diabetes: Preliminary data from a retrospective study of ICET-A Network

Oral glucose-lowering agents (GLAs) in β-thalassemia patients

Authors

Vincenzo De Sanctis Quisisana Hospital, Ferrara
Ashraf Soliman Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children’s Hospital, Alexandria, Egypt
Ploutarchos Tzoulis Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK
Shahina Daar Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
Antonis Kattamis Thalassemia Unit, Division of Pediatric Hematology-Oncology, First Department of Pediatrics, University of Athens, “Agia Sofia” Children’s Hospital, Athens, Greece
Polyxeni Delaporta Thalassemia Unit, Division of Pediatric Hematology-Oncology, First Department of Pediatrics, University of Athens, “Agia Sofia” Children’s Hospital, Athens, Greece
Mehran Karimi Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Mohamed A. Yassin National Center for Cancer Care and Research, Medical Oncology Hematology Section HMC, Doha, Qatar
Tahereh Zarei Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Forough Saki Shiraz Endocrinology and Metabolism Research Center, Shiraz, Iran
Katia Sapunarova Department of Hematology, University Hospital "Sv Georgi", Medical University of Plovdiv, Plovdiv, Bulgaria
Atanas Banchev Pediatric Hematology-Oncology, University Hospital “Tzaritza Giovanna - ISUL”, Sofia, Bulgaria
Maria Concetta Galati Department of Pediatric Haematoncology, Thalassaemia and Prenatal Diagnosis Regional Center, Pugliese- Ciaccio Hospital, Catanzaro, Italy
Giuseppe Raiola Department of Paediatrics, Pugliese-Ciaccio Hospital,Catanzaro, Italy
Giuseppe Messina UOSD Microcitemie, Grande Ospedale Metropolitano “Bianchi- Melacrino- Morelli”, Reggio Calabria, Italy
Saveria Campisi UOSD Thalassemia, Umberto I° Hospital, Siracusa, Italy
Christos Kattamis 15 First Department of Pediatrics, National Kapodistrian University of Athens, Greece

DOI: https://doi.org/10.23750/abm.v93i2.12056

Keywords:

β-thalassemia, glucose dysregulation, diabetes, glucose-lowering agents, outcome.

Abstract

Objective: The management of prediabetes and hyperglycemia is an increasingly important aspect of care in patients with thalassemia. In light of the limited evidence about the management of GD (glucose dysregulation) with glucose-lowering agents (GLAs), we have conducted a retrospective survey in TDT and NTDT patients with diabetes mellitus to collect more detailed information on GLA use in order to make preliminary recommendations. Study design and method: A questionnaire was prepared and distributed to the tertiary thalassemia care Centers of ICET-A Network. Results: Eight thalassemia care Centers [Bulgaria, Greece, Iran, Italy (4 Centers) and Qatar], following 1.554 with transfusion-dependent thalassemia (TDT), 132 (8.4%) with diabetes and 687 with non-transfusion-dependent thalassemia (NTDT), 27 (3.9%) with diabetes, participated in the retrospective survey. The records of 117 TDT patients and 9 NTDT patients with diabetes treated with GLAs were analyzed. Metformin, a biguanide, was the most frequently used drug (47.6 %), followed by alpha-glucosidase inhibitors (5.5 %), incretins (4.7%) and insulin secretagogues (3.1%). In 68 (61.2) patients GLAs was prescribed as monotherapy, while the remaining 49 (38.8%), who had inadequate glucose control with metformin, were treated with combination treatment. Fifty-one patients of 126 (40.4%) initially treated with oral GLA, for a mean duration of 61.0 ± 35.6 months (range: 12- 120 months), required insulin therapy for better metabolic control. Conclusion: This retrospective study covers an unexplored area of research in patients with thalassemia and GD. Oral GLAs appear to be safe and effective for the treatment of diabetes mellitus in patients with thalassemia, and can achieve adequate glycemic control for a substantial period of time.

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