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
From prediabetes to diabetes mellitus in thalassemia
Keywords:
β-thalassemia major, prediabetes, diabetes,OGTT, HOMA2- IR, HOMA2-% β, HOMA2-%S.Abstract
Background: Prediabetes in transfusion-dependent β-thalassemia (β-TDT) patients is a significant risk factor for development of diabetes mellitus (DM), with increasing incidence with age. Objectives: This retrospective study aimed to compare the progression from prediabetes to DM in β-TDT patients who initiated iron chelation therapy (ICT) before age 6 and between ages 6 and 10. Additionally, we sought to characterize the trajectories of fasting and post-glucose load insulin sensitivity and secretion (HOMA2-%S and HOMA2-% β) in a β-TDT subgroup, monitored annually for four years preceding DM diagnosis. Research Design and Methods: We retrospectively reviewed annual oral glucose tolerance test (OGTT) data for 18 β-TDT patients from Oman and Italy, from the onset of prediabetes to DM diagnosis. Results: The mean age at prediabetes diagnosis was 17.5 ± 4.2 years, and at DM diagnosis was 21.6 ± 5.2 years. A direct correlation was observed between the age at prediabetes and DM diagnosis (r: 0.6925, P: 0.0014). Three years before DM diagnosis, a notable increase in baseline, 1-hour, and 2-hour post-load plasma glucose levels during OGTT was observed, alongside a decrease in HOMA2-% β. Conclusions: Elevated 1-hour post-load plasma glucose levels and a declining HOMA2-% β during the transition to DM are indicative markers for identifying β-TDT patients with high likelihood for imminent progression to DM.
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