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

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

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.

References

References

Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the american diabetes association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43:487–493.

Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of

Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2019 executive summary. Endocr Pract. 2019;25:69–100.

De Sanctis V, Atti G, Lucci M, et al. Valutazione della funzionalità alfa e beta pancreatica nella beta-talassemia maior [Evaluation of alpha and beta pancreatic function in beta-thalassemia major]. Radiol Med. 1980;66:861-863. Italian

Soliman AT, el Banna N, alSalmi I, Asfour M. Insulin and glucagon responses to provocation with glucose and arginine in prepubertal children with thalassemia major before and after long-term blood transfusion. J Trop Pediatr. 1996 ;42:291-296.

Angelopoulos NG, Zervas A, Livadas S, et al. Reduced insulin secretion in normoglycaemic patients with beta-thalassaemia major. Diabet Med. 2006;23:1327-1331.

De Sanctis V, Soliman A, Tzoulis P, Daar S, Fiscina B, Kattamis C. The Pancreatic changes affecting glucose homeostasis in transfusion dependent β-thalassemia (TDT): a short review. Acta Biomed. 2021;92 (3):e2021232.

Merkel PA, Simonson DC, Amiel SA, et al. Insulin resistance and hyperinsulinemia in patients with thalassemia major treated by hypertransfusion. N Engl J Med. 1988; 318: 809-814.

Dmochowski K, Finegood DT, Francombe W, et al. Factors determining glucose tolerance in patients with thalassemia major. J Clin Endocrinol Metab. 1993;77: 478- 483.

Pappas S, Donohue SM, Denver AE, Mohamed-Ali V, Goubet S, Yudkin JS. Glucose intolerance in thalassemia major is related to insulin resistance and hepatic dysfunction. Metabolism.1996;45:652-657.

Cario H, Holl RW, Debatin KM, Kohne E. Insulin sensitivity and beta-cell secretion in thalassaemia major with secondary haemochromatosis: assessment by oral glucose tolerance test. Eur J Pediatr. 2003; 162:139-146.

De Sanctis V, Soliman AT, Tzoulis P, et al. Glucose metabolism and insulin response to oral glucose tolerance test (OGTT) in prepubertal patients with transfusion dependent β-thalassemia (TDT): A long-term retrospective analysis. Mediterr J Hematol Infect Dis.2021, accepted for publication.

De Sanctis V, Soliman A, Tzoulis P, et al. The Prevalence of glucose dysregulations (GDs) in patients with β-thalassemias in different countries: A preliminary ICET-A survey. Acta Biomed. 2021;92(3):e2021240.

Tzoulis P, Shah F, Jones R, Prescott E, Barnard M. Joint diabetes thalassaemia clinic: an effective new model of care. Hemoglobin. 2014;38:104-110.

Jones TW, Boulware SD, Caprio S, et al. Correction of hyperinsulinemia by glyburide treatment in nondiabetic patients with thalassemia major. Pediatr Res. 1993;33:497-500.

Ladis V, Theodorides C, Palamidou F, et al. Glucose disturbances and regulation with glibenclamide in thalassemia. J Pediatr Endocrinol Metab. 1998;11 (Suppl 3) :871-878.

Mangiagli A, Campisi S, De Sanctis V, et al. Effects of acarbose in patients with beta-thalassaemia major and abnormal glucose homeostasis. Pediatr Endocrinol Rev. 2004 ;2 ( Suppl 2):276-278.

Dhouib N, Turki Z, Mellouli F, et al. Efficacy of metformin in the treatment of diabetes mellitus complicating thalassemia major. Tunis Med. 2010;88:136.

Zonoozi S, Barnard M, Prescott E, Jones R, Shah FT, Tzoulis P. Effectiveness and safety of sitagliptin in patients with beta-thalassaemia major and diabetes mellitus: a case series. Mediterr J Hematol Infect Dis. 2017, 9(1): e2017004.

De Sanctis V, Zurlo MG, Senesi E, Boffa C, Cavallo L, Di Gregorio F. Insulin dependent diabetes in thalassaemia. Arch Dis Child. 1988;63:58-62.

Cone CJ, Bachyrycz AM, Murata GH. Hepatotoxicity associated with metformin therapy in treatment of type 2 diabetes mellitus with nonalcoholic fatty liver disease. Ann Pharmacother. 2010;44:1655-1659.

Gangopadhyay KK, Singh P. Consensus statement on dose modifications of antidiabetic agents in patients with hepatic impairment. Indian J Endocr Metab. 2017;21:341-354.

Kosecki SM, Rodgers PT, Adams MB. Glycemic monitoring in diabetics with sickle cell plus beta-thalassemia hemoglobinopathy. Ann Pharmacother. 2005; 39:1557-1560.

De Sanctis V, Soliman AT, Daar S, Di Maio S, Elsedfy H, Kattamis C. For Debate: Assessment of HbA1c in Transfusion Dependent Thalassemia Patients. Pediatr Endocrinol Rev. 2020 Jun;17(3):226-234.

Kattamis C, Delaporta P, Dracopoulou M, et al. Credibility of HbA1c in diagnosis and management of disturbances of glucose and diabetes in transfused patients with thalassemia. Riv Ital Med Adolesc. 2014; 12:65-71.

Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 2020; 43: 487–493.

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Published

11-05-2022

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ORIGINAL ARTICLES

How to Cite

1.
De Sanctis V, Soliman A, Tzoulis P, Daar S, Kattamis A, Delaporta P, et al. 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. Acta Biomed [Internet]. 2022 May 11 [cited 2024 Jul. 22];93(2):e2022162. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/12056