Effects of iron- chelation therapy intensification on glucose homeostasis during 3-h oral glucose tolerance test (OGTT) in transfusion-dependent β-thalassemia patients (β-TDT)

Vincenzo De Sanctis; Shahina   Daar; Ashraf   Soliman; Saveria   Campisi; Ploutarchos   Tzoulis

doi:10.23750/abm.954.16013

Authors

Vincenzo De Sanctis Quisisana Hospital, Ferrara
Shahina Daar Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
Ashraf Soliman Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar
Saveria Campisi UOSD Thalassemia, Umberto I Hospital, Siracusa, Italy
Ploutarchos Tzoulis Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK

Keywords:

Transfusion-dependent thalassemia, iron overload, intensification chelation therapy, OGTT, follow-up

Abstract

Background: Iron overload (IOL) due to chronic transfusion therapy in β-thalassemia major (β-TDT) patients leads to multi-organ damage, including glucose dysregulation (GD). The effectiveness of intensified iron chelation therapy (ICT) on glucose homeostasis and its ability to reverse iron-induced endocrinopathies is not fully understood. Objectives: To assess the effects of intensified ICT on glucose homeostasis, insulin secretion, and sensitivity in adolescent and very young adult β-TDT patients with moderate to severe IOL. Methods: This retrospective study evaluated 19 β-TDT patients who underwent intensified ICT with the aim of reducing serum ferritin (SF) to 500-1,000 ng/mL. Over a median follow-up of 4.2 years, parameters including oral glucose tolerance test (OGTT), insulin response, and serum ferritin levels were analyzed. Results: Despite a marked reduction in SF and IOL, the prevalence of GD remained unchanged (P= 0.75). Some patients showed improvement in glucose tolerance, whereas other developed new endocrine disorders, such as hypogonadotropic hypogonadism and secondary amenorrhea. Improvements were seen in insulin sensitivity, but not in pancreatic β-cell function. Conclusion: Intensified ICT in β-TDT patients, albeit effectively reducing iron burden, did not uniformly reverse established glucose homeostasis disorders. While some endocrine functions improved, others deteriorated or developed a new complication, suggesting that more aggressive or prolonged ICT may be necessary. Long-term studies are required to better understand the impact of ICT on endocrine organ function. (www.actabiomedica.it)

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