Diabetes Mellitus in Children Suffering from  -Thalassaemia

Abstract

Insulin-dependent diabetes mellitus (IDDM) is a frequent complication in patients with beta-thalassaemia major. It is believed to be a consequence of the damage inflicted by iron overload to the pancreatic beta-cell. Liver disorders and genetic influences seem to be additional predisposing factors to diabetes mellitus in patients with beta-thalassaemia. Ethnic variations are frequently reported on prevalence and complications of diabetes mellitus in the beta-thalassaemia patients. We investigated 50 Saudi children (< 15 years) with beta-thalassaemia major and 50 beta-thalassaemia minor, and age- and sex-matched controls for the prevalence of diabetes mellitus, and its relation to hitherto claimed predisposing factors. Fasting blood glucose, plasma insulin level, liver function tests, plasma ferritin, iron, and transferrin were assessed in each patient and glucose tolerance was evaluated. Results in patients with beta-thalassaemia major were compared with those obtained for beta-thalassaemia minor and the controls. The results showed moderate elevation of ferritin level in the majority of the beta-thalassaemia major despite desferroxamine therapy. Either hyperinsulinaemia or hypoinsulinaemia was encountered in the majority of these patients. The prevalence of diabetes mellitus was 6 per cent compared to 2 per cent in the beta-thalassaemia minor and normal children. Impaired glucose tolerance (IGT) occurred at a significantly higher (24 per cent) frequency in the beta-thalassaemia major compared to 2 and 0 per cent in the beta-thalassaemia minor patients and normal controls, respectively. The prevalence of diabetes mellitus was significantly lower in the Saudi thalassaemic patients compared to the results obtained from patients of other ethnic groups reported in literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of Serum Insulin, Glucose, Lipid Profile, and Liver Function in β-Thalassemia Major Patients and Their Correlation With Iron Overload

“…25 To this date, numerous reports on iron overload and endocrine problems, especially diabetes mellitus in thalassemic patients, have been published, and the reported incidence of impaired glucose tolerance and diabetes mellitus in TM are 0%-26%. 12,18,[27][28][29] In our study 17.9% of patients had abnormal serum glucose: 5.1% with overt diabetes, 5.1% with suspicions of diabetes, and the remaining with IFG.…”

“…1-6 β-TM is 1 of the most common genetic disorders in Asia and Iran. 12,[18][19][20] Although an increasing number of patients are now treated with bone marrow transplantation, the majority of the patients still depend on regular transfusions. 21,22 Regular transfusion and chelation therapy have improved the span and quality of their lives, but many patients suffer from clinical complications resulting from iron overload.…”

“…10,11 Glucose intolerance is a common consequence of transfusion therapy in patients with TM, but the relative contribution of pancreatic damage and insulin resistance to glucose intolerance is unclear. [12][13][14][15] The exact mechanism of iron-induced diabetes is unclear, but it most likely occurs through these 3 mechanisms: (1) insulin deficiency, (2) insulin resistance, and (3) hepatic dysfunction. 9 Although numerous studies have been performed on endocrine and liver complications in thalassemia, the number of published studies about Iranian patients is significantly small.…”

Relationship between beta-globin gene carrier state and insulin resistance

“…The prevalence of impaired glucose tolerance was, similarly, higher in patients with thalassemia major compared to those suffering from thalassemia minor and healthy subjects. In this study, subjects were not matched in terms of BMI and family history of diabetes; both of which play an important role in the development of diabetes and insulin resistance [9]. …”

Glucose homeostasis in Egyptian children and adolescents with β-Thalassemia major: Relationship to oxidative stress

“…In addition, controversy about the etiology of this glycemia abnormality still exists. [345] Decreased or impaired β-globin biosynthesis in β-thalassemia leads to ineffective erythropoiesis and plays a crucial role in producing the role of oxidative stress in thalassemic patients. [6] Glucose homeostasis and its relation to oxidative stress has not been widely studied especially in Egyptian children and aldolescents with β-thalassemia major.…”