Effect of enhanced iron chelation therapy on glucose metabolism in patients with β‐thalassaemia major

Abstract

Summary Recently introduced chelation regimens that combine deferoxamine (DFO) and deferiprone have been shown to have greater efficacy in promoting iron excretion than either chelator alone and have been associated with rapid reduction of the iron load in the heart and liver, and with reversal of cardiac dysfunction. It is unclear whether this combined therapy could be associated with a reduction in iron load or decline in the severity of iron‐induced endocrinopathies. Starting in January 2001, 42 patients with β‐thalassaemia major, previously maintained on subcutaneous DFO only, were switched to combined treatment with DFO and deferiprone. The primary endpoint was to investigate the effects of this therapy on the glucose metabolism characteristics of this population. Combination therapy markedly decreased ferritin levels (638 ± 1345 vs. 2991 ± 2093 μg/l, P < 0·001). Glucose responses were improved at all times during an oral glucose tolerance test, particularly in patients in early stages of glucose intolerance. Glucose quantitative secretion also decreased significantly with combined therapy, while no significant change occurred in insulin levels in any group. Insulin secretion, according to the homeostasis assessment model, markedly increased in all groups, while overall reduction in insulin sensitivity did not reach statistical significance. This study showed that the combination of DFO and deferiprone was associated with an improvement in liver iron deposition and glucose intolerance.

A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major

“…Irrespective of the mechanism, these parameters are known to improve with intense chelation, especially in patients with impaired glucose tolerance. 19 It is likely, therefore, that advancement in iron assessment and chelation will not only reduce cardiac morbidity but will impact on future diabetic Figure 1C. Correlation between pancreatic T2* log with Heart MRI T2*.…”

Acute cardiac decompensation in a patient with beta‐thalassemia and diabetes mellitus following cessation of chelation therapy

“…The beta‐cell is particularly sensitive to oxygen radicals and this may explain insulinopenia in many patients with beta‐thalassemia. In studies (of limited numbers of patients), iron chelation with deferoxamine may improve glucose handling 25, 26.…”

Diabetes Mellitus and Impaired Glucose Tolerance in β-Thalassaemia Major Patients with Secondary Haemchromatosis: Frequency and their Associations from a Developing Country

“…A study of 142 chronically transfused patients with beta thalassaemia major noted diabetes mellitus in 14.6% cases with mean 12 years of transfusion and an average serum ferritin of 2000 μg/l [13].…”