Acute Effects of Blood Transfusion on Insulin Sensitivity and Pancreatic β-Cell Function in Children with β-Thalassemia/Hemoglobin E Disease

Abstract

Objective:To assess the acute effects of blood transfusion on insulin sensitivity and pancreatic β-cell function in thalassemia patients.Methods:Fifty children and adolescents with β-thalassemia/HbE disease were enrolled in a prospective cohort study. Hemoglobin, serum ferritin and oral glucose tolerance test (OGTT) were performed prior to, and one week after blood transfusion. Insulin sensitivity indices [homeostatic model assessment (HOMA) of insulin resistance (HOMA-IR), whole body insulin sensitivity index (WBISI)] and β-cell function indices [HOMA of β-cell function (HOMA-β), insulinogenic index (IGI), and disposition index (DI)] were calculated from glucose and insulin levels obtained during the OGTT.Results:Following blood transfusion, hemoglobin and serum ferritin increased significantly; 8.5 to 10.1 g/dL (p<0.001) and 1764 to 2160 ng/mL (p<0.001), respectively. β-Cell function indices also increased significantly [median HOMA-β: 74.3 vs. 82.7 (p=0.033); median IGI: 59.6 vs. 79.3 (p=0.003); median DI: 658 vs. 794 (p=0.01)]. However, the insulin sensitivity index (WBISI) tended to decrease and the insulin resistance index (HOMA-IR) tended to increase although this did not reach significance. Multivariate analysis showed that pre-transfusion serum ferritin was the major factor negatively associated with WBISI and positively associated with HOMA-IR, but pre-transfusion hemoglobin had no significant association with insulin sensitivity indices post-transfusion.Conclusion:This study demonstrated that acute increases in serum ferritin and hemoglobin following blood transfusion in patients with thalassemia might contribute to an increase in insulin secretion and to a trend towards increased insulin resistance.

Concise Review on the Frequency, Major Risk Factors and Surveillance of Hepatocellular Carcinoma (Hcc) in Β-Thalassemias: Past, Present and Future Perspectives

“…Disturbances of glucose homeostasis, ranging from mild glucose intolerance to overt diabetes mellitus, and hyperinsulinism were reported in young adult patients with thalassemia and have been attributed to iron overload, HCV infection, anemia, and chronic liver disease. 66,67 An acute effect of blood transfusion on insulin sensitivity and β-cell function in patients with thalassemia has been reported by Wankanit et al 68 Alcohol and Tobacco. Alcohol and iron are known prooxidants, and oxidative stress is known to play an essential role in the development of several diseases, including cancer.…”

Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery

“…Previous studies have shown that blood transfusion in thalassemia patients causes acute increases in serum ferritin and hemoglobin which contribute to an increase in insulin resistance. [27] We postulate that this could partly account for the development of postoperative hyperglycemia among our patients who received blood transfusions, given the relatively high prevalence of thalassemia in Asian populations.…”

Abnormal glucose homeostasis in patients of HbEβ-thalassemia: Prevalence and possible pathogenesis using the Oxford HOMA model

“…Wankanit et al showed a 14% prevalence of abnormal OGTT in HbEβ-thalassemia patients. [28] e prevalence of AGH in both β-thalassemia major and HbEβ-thalassemia patients is seen to have an earlier onset than in the age-matched general population.…”