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

Metwalley, Kotb Abbass; El-Saied, Abdel Rahman Abdel-Hamed

doi:10.4103/2230-8210.131169

Cited by 17 publications

(20 citation statements)

References 20 publications

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“…The prevalence of glucose metabolism dysregulation found in our study was much higher than 13%, which was reported by Metwalley et al . (2014) involving 60 thalassaemic children . This wide variation in prevalence was multifactorial: dependent on the duration of blood transfusion, degree of iron load, organ dysfunction, type of chelators, compliance to therapy and age of patient .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of diabetes mellitus in Chinese children with thalassaemia major

Liang

Bajoria

Jiang

et al. 2017

Tropical Med Int Health

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Abstractobjective Diabetes mellitus is a common endocrinopathy in patients with b-thalassaemia major (b-TM), which is high prevalent in southern China. This study aimed to determine the cause and prevalence of glycaemic disorders in Chinese children with b-TM.methods In this prospective study, fasting glucose and insulin (FINS) levels were assessed in 267 b-TM and 80 non-TM control children. Homeostatic model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI) were evaluated. Iron overload was assessed by serum ferritin (SF), total units of blood transfused and cardiac T2*.results b-TM had higher FPG (P < 0.001), FINS (P < 0.001) and HOMA-IR (P < 0.05), but lower QUICKI (P < 0.01) than those of controls. The impaired fasting glucose (IFG) was present in 30% of children, whereas 2% had diabetes. The prevalence of IFG in b-TM group was higher in children aged >10 years (OR 6.5; 95% CI 3.7-11.4; P < 0.001), SF of >2500 lg/l (OR 4.8; 95% CI 2.1-11.1; P < 0.01), serum ALT levels of >50 IU/l (OR 2.1; 95% CI 1.2-3.7; P < 0.05) and cardiac T2* of <20 ms (OR 3.3; 95% CI 1.7-6.6; P < 0. 01). The children on deferiprone (DFP) had a reduced incidence of glycaemic aberrations than those on other chelating agents (OR 0.4; 95% CI 0.23-0.8; P < 0.05).conclusions Our data suggest that IFG occurred in 30% of b TM children, perhaps due to insulin resistance secondary to iron overload. Deferiprone-containing chelating agent may have a protective effect.keywords thalassaemia major, iron overload, insulin resistance diabetes, cardiac load, short stature

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Section: Discussionmentioning

confidence: 99%

Prevalence of diabetes mellitus in Chinese children with thalassaemia major

Liang

Bajoria

Jiang

et al. 2017

Tropical Med Int Health

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“…Just over one‐quarter (27.5%) of patients with Hb H disease had insulin resistance, as measured by HOMA‐IR that was significantly related to obesity, but not with iron overload or anemia. Insulin resistance has been extensively studied among patients with TDT (mainly β‐thalassemia major), and it is known to be related to the severity of iron overload . Meanwhile, studies in NTDT patients (mostly β‐thalassemia intermedia) with iron overload reported variable prevalence of impaired glucose tolerance and DM .…”

Section: Discussionmentioning

confidence: 99%

Early development of decreased β‐cell insulin secretion in children and adolescents with hemoglobin H disease and its relationship with levels of anemia

Nakavachara

Kajchamaporn

Pooliam

et al. 2019

Pediatric Blood & Cancer

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Background Diabetes mellitus (DM) associated with iron overload has been reported among adults with transfusion‐dependent thalassemia and those with non‐transfusion‐dependent thalassemia (NTDT), especially in β‐thalassemia disease. However, little is known about glucose metabolism and how early its dysregulation can develop in α‐thalassemia hemoglobin H (Hb H) disease, which is one of the most common types of NTDT worldwide. Procedure We prospectively calculated glucose metabolism index in 40 patients (aged 10–25 years) with Hb H disease. Glucose metabolism data were compared between patients with deletional versus nondeletional Hb H, and between patients with normal versus abnormal insulin secretion/sensitivity. Results Despite normal glucose tolerance in all patients, 52.5% had abnormal insulinogenic index indicating decreased β‐cell insulin secretion. Patients with functional hemoglobin < 8 g/dL had significantly higher percentages of abnormal insulinogenic index. There was no significant difference in abnormal insulinogenic index between deletional and nondeletional Hb H. Conclusion Decreased β‐cell insulin secretion is highly prevalent among children and adolescents with Hb H disease, and it is associated with levels of functional anemia at baseline, but not with the type of Hb H disease. This result warrants heightened awareness among hematologists due to potentially increased risk of DM later in life.

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“…Metwalley and El‐Saied evaluated glucose homeostasis in Egyptian children and adolescents with β‐TM. The prevalence of diabetes was 5% (3 of 60) and IGT was 8% (5 of 60).…”

Section: Discussionmentioning

confidence: 99%

“…The difference was more evident in patients with abnormal OGTT and those who did not receive chelation or were on irregular chelation therapy. Therefore, they suggested regular iron chelation for thalassemia patients to improve glucose hemostasis and recommended that OGTT and HOMA‐IR should be an integral part of the long‐term follow‐up of children and adolescents with β‐TM …”

Section: Discussionmentioning

confidence: 99%

Evaluation of continuous glucose monitoring system for detection of alterations in glucose homeostasis in pediatric patients with β-thalassemia major

et al. 2018

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Background Disturbances of glucose metabolism are common in β‐thalassemia major (β‐TM). Aim This study was conducted to assess the pattern of glucose homeostasis in pediatric β‐TM patients comparing oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS). Methods Two‐hundred β‐TM patients were studied and those with random blood glucose (RBG) ≥7.8 mmol/L (140 mg/dL) were subjected to OGTT, insertion of CGMS and measurement of fasting C peptide, fasting insulin, and hemoglobin A1c (HbA1c). Results Twenty patients (10%) had RBG ≥ 7.8 mmol/L. Using OGTT, 6 out of 20 patients (30%) had impaired glucose tolerance (IGT) while 7 (35%) patients were in the diabetic range. CGMS showed that 7/20 (35%) patients had IGT and 13 (65%) patients had diabetes mellitus (DM); 10 of the latter group had HbA1c readings within diabetic range. The percentage of diabetic patients diagnosed by CGMS was significantly higher than that with OGTT (P = 0.012). Serum ferritin was the only independent variable related to elevated RBG. All β‐TM patients with DM were non‐compliant to chelation therapy. Conclusions The use of CGMS in the diagnosis of early glycemic abnormalities among pediatric patients with β‐TM appears to be superior to other known diagnostic modalities.

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

Cited by 17 publications

References 20 publications

Prevalence of diabetes mellitus in Chinese children with thalassaemia major

Prevalence of diabetes mellitus in Chinese children with thalassaemia major

Early development of decreased β‐cell insulin secretion in children and adolescents with hemoglobin H disease and its relationship with levels of anemia

Evaluation of continuous glucose monitoring system for detection of alterations in glucose homeostasis in pediatric patients with β-thalassemia major

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