The different patterns of insulin response during Oral Glucose Tolerance Test (OGTT) in transfused young patients with β-Thalassemia. Insulin response patterns during OGTT in thalassemia

Main Article Content

Christos Kattamis
Vassilis Ladis
Myrto Skafida
Nicoletta Iacovidou
Charalambos Theodoridis

Keywords

b-thalassemia, glucose metabolism, OGTT, Insulin resistance

Abstract

Background and aim. Dysregulation of glucose metabolism is a common complication of transfusions in Transfusion Dependent Thalassemia (TDT) patients. For early diagnosis of glucose disturbances, screening is recommended. The age of starting and the type of screening vary; the more common methods are assessment of RPG, FPG, 2h PG and 2 hours OGTT. The combined assessment of glucose tolerance and insulin response during OGTT is rarely recommended. The main objective of the study is the evaluation of simultaneous assessment of Glucose Tolerance (GT) and Insulin Response (IR) during OGTT in patients with TDT.


Methods. 43 TDT patients aged 12-28years, without clinical evidence of glucose disturbances, were randomly selected for the study. The 2-hour OGTT in 30 minutes intervals was applied. Plasma glucose and insulin were assessed in all samples using routine laboratory methods.


Results. Of 43 patients 31(72%) had Normal GT; of them 9 (29%) had normal insulin response  (NIR), 14 (45%) high IR and 8(26%) delayed peak IR. Delayed peak IR was found in 8 of the 9 patients with Impaired GT and in 2 of the 3 with diabetic GT. Deficient IR (hypoinsulinemia) was found in two patients.


Conclusions. Simultaneous assessment of GT and IR during OGTT in TDT patients, seems to be a most sensitive and creditable screening test for early diagnosis of glucose disturbances. High IR and delayed peak IR in normoglycemic patients are valuable indices for diagnosis of the pre-diabetic state that precede the development of glucose disturbances in TDT patients and start proper follow and management.

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References

1. Dmochowski K, Finewood D, Francobe W, Tyler B, Zinman B. Factors determining glucose tolerance in thalassemia. I Clin Endocrino Metab 1993;77: 448-47
2. De Sanctis V, Soleman AT, Yassin M. Iron load and glucose metabolism in subjects with β-thalassemia major. Αn overview . Curr Diabetes Reν . 2012; 9: 332-341.
3. De Sanctis V, Soleman AT, Elsedfy H, et al H. Diabetes and glucose metabolism in thalassemia major. An update. Expert Rev. Hematolog 2016; 9: 401-408.
4. Mowla A, Karimi M, De Sanctis V. Prevalence of diabetes mellitus and impaired glucose in β-thalassemia patients with or without hepatis C virus. Pediatr Endocrinol Rev. 2004; Suppl 2: 282-4.
5. He LN, Chen W, Yang Y et al . Prevalence of abnormal glucose metabolism and other endocrine disorders in patients wit β-Thalassemia Major. A meta analysis. Biomed Res Int 2019 April 18; 2019 2019:6573497. Doi 10.1155/2019/6573497.
6. De Sanctis V, Soleman AT, Daar S et al. Detecting glucose related disturbances in patients with Transfusion Depended Thalassemia .From old to new concept. RIMA (Endo Thal) 2019; 17(2) 41-52.
7. De Sanctis V, Soliman AT, Elsedfy H et al . The ICET-A recommendations for the diagnosis and management of disturbances of glucose homeostasis in Thalssemia Major patient. Mediterr J Hematol Infect Dis. 2016; 8: e2016058 .
8. American Diabetes Association. Classification and diagnosis of Diabetes: Standards of Medical Care. Diabetes Care 2020; 43 (Suppl 1): S14-S31.
9. Kattamis C, Ladis V, Tsousis D, Kalounenou I, Theodoridis C. Evolution of glucose intolerance and diabetes in transfused patients with thalassemia. Pediatr Endocrinol Rev 2004; 2 Suppl 2 : 267 -271.
10. Kattamis C, Theodoridis C, Kanavakis E. Intravenous glucose and plasma insulin in children with homozygous β-thalassemia. Aust Paediatr J. 1982; 18: 186-7
11. Suvarna J, Ingle H , Deshmukh CT. Insulin resistance and beta cell function in chronically transfused patients of thalassemia major. Indian Pediatr 2006; 43: 393-400
12. Angelopoulos NG, Zervas A , Livadas S, et al. Reduced insulin secretion in normoglycemic patients with beta thalassemia major. Diabet Med 2006;23: 1327-1331.
13. Cario H, Holl RW , Debatin KM, , Kohn E. Insulin sensitivity and beta cell secretion in thalassemia major with secondary haemochromatosis: assessment by oral glucose tolerance test. Eur J Pediatrics . 2003; 162: 139-146.
14. Mathews DR, Hosker JP, Rundeski et al. Homeostasis model assessment: insulin resistance and β- cell function from fasting plasma glucose and insulin concentration in man. Diabetologia 1985;28:412-19.I
15. Ladis V, Theodoridis C, Palamidou F, Frisiras S, Berdousi H, Kattamis C. Glucose disturbances and regulation with glibenclamide in thalassemia. J Pediatr Endocrnol Metab 1998; 11 (Suppl 3): 871- 877.

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