Endocrine Abstracts

We studied retrospectively the changes of glucose-insulin homeostasis from early childhood to young adulthood in β-thalassemia major (β -TM) patients with impaired fasting glucose (IFG) vs those with normal OGTT.

Methods: All data entered in the database of β -TM patients’ records from September 1983 to September 2021 were included in the study.

Results: The occurrence of dysglycemia (GD) (IFG, IGT and IFG + IGT) after 20 years of follow up was markedly higher in the group with IFG at the beginning of the study compared to the group with normal OGTT. There was no case of diabetes mellitus. In patients who had normal OGTT at baseline, a small proportion developed GD (2/9 at 15 years and only 1/8 at 20 years). On the other hand, 3 out of 9 patients with baseline IFG, had persistent IFG at 5 years. One had persistent isolated IFG and 3 developed IGT 10 years later. 5/9 had IFG after 15 years, and finally 6/8 had GD after 20 years. (table)Indices of insulin secretion and sensitivity (MI, HOMA-IR, oDI) were statistically different (P=< 0.001) between the two groups. HOMA-IR was higher in patients who had IFG vs (6/9 patients had HOMA-IR > 2.24) vs the group with normal OGTT (2/6 patients had HOMA-IR > 2.24). This suggested a degree of insulin resistance in the etiology of GD.In both groups of patients, no correlation was observed between serum ferritin (SF), ALT and indexes of insulin sensitivity or insulin resistance.

Conclusion: Our data advocates that baseline IFG predicts future development of GD because almost half of patients with IFG at the outset had abnormal glucose handling 15 years later. Understanding the sequence of abnormalities in the progression from normal glucose homeostasis to GD and identifying the risk factors for the glycol-metabolic defects in thalassemia patients might help in the formulation of interventions.