The credibility of intermediate hyperglycemia (IH) at one hour of OGTT in 30 β-thalassemia patients (β-thal) with persistent low iron overload
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Background: Intermediate hyperglycemia (IH) at 1-hour during oral glucose tolerance test (OGTT) has received attention as a useful early biomarker of dysglycemia. Objective: The main objective of this study was to gain further insight into IH in 30 β-thalassemia (β-thal) patients with a spectrum of genotypes and persistent low iron load (serum ferritin; SF:<1,000 μg/L), related to effective treatment with oral iron chelation monotherapy. Methods: OGTT was performed according to the American Diabetes Association (ADA) guidelines. Venous blood samples for PG and insulin assays were collected at 0, 60, and 120 minutes after glucose load for PG and insulin assays. Results: Based on the OGTT results, 13 out of 30 patients (43.3%) had normal glucose tolerance (NGT), and 4 out of 32 (12.5%) patients impaired fasting glucose (IFG). Interestingly, isolated IH (i-IH at 1-hour post-OGTT: PG: ≥ 155 mg/dL) and type 2 diabetes mellitus at 1-hour post-OGTT (PG : ≥ 209 mg/dL) were detected in 5 (16.6%) and 3 (10%) out of 30 patients, respectively. IH associated with IFG and impaired glucose tolerance (IGT) was detected in 3 (10%) and 2 (6.6%) out of 30 patients, respectively. β-TDT patients were divided into two subgroups: those with NGT and those with IH. A statistically significant difference between the two groups was observed only for the HOMA 2 - % β index (P = 0.042). Conclusion: Intermediate hyperglycemia at 1-hour during OGTT in β-thal is a sensitive index to identify early glucose dysregulation even in patients with NGT.
References
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: 2830-9. doi.org/10.2337/dc20-0908.
Meloni A, Restaino G, Missere M, et al. Pancreatic iron overload by T2* MRI in a large cohort of well treated thalassemia major patients: can it tell us heart iron distribution and function? Am J Hematol. 2015; 90:E189-90.10.1002/ajh.24081.
Huang J, Shen J, Qihua Yang Q, et al. Quantification of pancreatic iron overload and fat infiltration and their correlation with glucose disturbance in pediatric thalassemia major patients. Quant Imaging Med Surg. 2021; 11: 665–75. doi: 10.21037/qims-20-292.
Meloni A, Nobile M, Keilberg P, et al. Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major. Eur Radiol.2023; 33: 7215–25. doi: 10.1007/s00330-023-09630-z.
Ricchi P, Meloni A, Pistoia L, et al. Longitudinal prospective comparison of pancreatic iron by magnetic resonance in thalassemia patients transfusion-dependent since early childhood treated with combination deferiprone-desferrioxamine vs deferiprone or deferasirox monotherapy Blood Transfus. 2024; 22:75–85.
doi: 10.2450/BloodTransfus.485.
Meloni A, Pistoia L, Ricchi P, et al. Link between genotype and multi-organ iron and complications
in children with transfusion- dependent thalassemia. J Pers Med. 2022; 12: 400. doi:10.3390/ jpm12030400.
Au WY, Lam WWM, Chu W, et al. A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major. Haematologica. 2008; 93:116-9. doi:10.3324/haematol.11768.
Bergman M, Manco M, Satman I, et al. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes. Diabetes Res Clin Pract. 2024;209:111589. doi: 10.1016/j.diabres.2024.111589.
American Diabetes Association Professional Practice Committee. Diabetes care in the hospital standards: Standards of care in diabetes-2024. Diabetes Care. 2024; 47 (Suppl. 1):S295–S306. doi: 10.2377/dc24-S016.
De Sanctis V, Daar S, Soliman A, Campisi S, Tzoulis P. Long-term retrospective study on the progression of prediabetes to diabetes mellitus in transfusion-dependent β-thalassemia (β-TDT) patients: The experience in Oman and Italy. Acta Biomed 2024;95: e2024050. doi: 10.23750/abm.v95i1.15525.
De Sanctis V, Soliman A, Tzoulis P, Daar S, Pozzobon GC, Kattamis C. 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. Acta Biomed. 2021; 92(4): e2021322. doi:10.23750/abm.v92i4.11105.
Maggio A, Giambona A, Cai SP, Wall J, Kan YW, Chehab FF. Rapid and simultaneous typing of hemoglobin S, hemoglobin C, and seven Mediterranean beta-thalassemia mutations by covalent reverse dot-blot analysis: application to prenatal diagnosis in Sicily.Blood.1993;81:239-42.PIMD 8417793.
Farmakis D, Porter J, Taher A, Cappellini MD, Angastiniotis M, Eleftheriou A. 2021 Thalassaemia International Federation Guidelines for the Management of Transfusion dependent Thalassemia. Hemasphere. 2022;6(8):e732. doi:10.1097/HS9.0000000000000732.
Taher AT, Musallam KM, Cappellini MD. β-Thalassemias. N Engl J Med. 2021;384:727-43.doi: 10.1056/ NEJMra2021838.
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.doi:10.4103/2230-8210.107808.
American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes - 2020. Diabetes Care. 2020; 43(Suppl.1): S14-S31. doi.org/10.2337/dc20-S002.
Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998;21:2191–2. doi.org/10.2337/diacare.21.12.2191.
Cazzola M, De Stefano P, Ponchio L, et al. Relationship between transfusion regimen and suppression of erythropoiesis in beta-thalassaemia major. Br J Haematol.1995; 89:473–8.doi:10.1111/j.1365-2141.1995. tb08351.x.
Trompeter S. Blood transfusion: Criteria for initiating transfusion therapy. In: 2021 Guidelines for the management of transfusion dependent thalassemia (TDT). Ed: MD Cappellini, D Farmakis D, J Porter, A Taher. Thalassaemia International Federation. Nicosia (Cyprus).2021; 4 th Edition, pag. 43.
De Sanctis V, Soliman AT, Tzoulis P, Daar S, Fiscina B, Kattamis C. Pancreatic changes affecting glucose homeostasis in transfusion dependent β-thalassemia (TDT): a short review. Acta Biomed. 2021; 92(3): e 20 21232. doi: 10.23750/abm.v92i3.11685.
De Sanctis V, Soliman AT, Daar S, et al. A prospective guide for clinical implementation of selected OGTT- derived surrogate indices for the evaluation of β- cell function and insulin sensitivity in patients with transfusion-dependent β- thalassaemia β-thalassemia and OGTT surrogate indices, Acta Biomed 2023;94(6): e2023221. doi: 10.23750/abm.v94i6.15329.
Berdoukas V, Nord A, Carson S, et al. Tissue iron evaluation in chronically transfused children shows significant levels of iron loading at a very young age. Am J Hematol 2013;88: E 283-5.dpo:10.1002/ ajh. 23543.
Pepe A , Pistoia L, Campisi S, et al. Pancreatic iron and glucidic metabolism in thalassemia major. Blood. 2019; 134 (Supplement 1): 3551.doi.org/10.1182/blood-2019-121876.
De Sanctis V, Daar S, Soliman AT, Tzoulis P, Yassin M, Kattamis C. The effects of excess weight on glucose homeostasis in young adult females with β-thalassemia major (β-TM): A preliminary retrospective study. Acta Biomed. 2023; 94(5): e2023225.doi: 10.23750/abm.v94i5.14909.
Fiorentino TV, Marini MA, Elena SuccurroE, et al. One-hour postload hyperglycemia: Implications for prediction and prevention of type 2 diabetes. J Clin Endocrinol Metab 103: 3131–43, 2018. doi:10.1210/ jc.2018-00468.
Bergman M. The 1-hour plasma glucose: Common link across the glycemic spectrum. Front Endocrinol (Lausanne). 2021;12:752329. doi:10.3389/fendo.2021.752329.
Fung EB, Gildengorin G,Talwar S, Hagar L, Lal A. Zinc status affects glucose homeostasis and insulin secretion in patients with thalassemia. Nutrients. 2015; 7: 4296–4307. doi: 10.3390/nu7064296.
Dikker O, Türkkan E, Dağ NC, Dağ H. Zinc levels in beta-thalassemia major: A Review of the Literature. Med Sci Discov. 202; 8:348–51.doi.org/10.36472 /msd. v8i6.547
Zekavat OR, Bahmanjahromi A, Haghpanah S, Ebrahimi S, Cohan N. The zinc and copper levels in thalassemia major patients, receiving iron chelation therapy. J Pediatr Hematol/Oncol. 2018;40:178–81. doi: 10.1097/MPH.00000000000011021016/j.jtemb.2012.10.002.
Darvishi-Khezri H, Karami H, Naderisorki M, et al. Two risk factors for hypozincemia in diabetic β-thalassemia patients: Hepatitis C and deferasirox. PLoS One.2024; 19(1): e0284267. doi: 10.1371/journal. pone.0284267.
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