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Evangelidis P, Venou TM, Fani B, Vlachaki E, Gavriilaki E. Endocrinopathies in Hemoglobinopathies: What Is the Role of Iron? Int J Mol Sci 2023; 24:16263. [PMID: 38003451 PMCID: PMC10671246 DOI: 10.3390/ijms242216263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Hemoglobinopathies, including β-thalassemia and sickle cell disease (SCD), are common genetic blood disorders. Endocrine disorders are frequent manifestations of organ damage observed mainly in patients with β-thalassemia and rarely in SCD. Iron overload, oxidative stress-induced cellular damage, chronic anemia, and HCV infection contribute to the development of endocrinopathies in β-thalassemia. The above factors, combined with vaso-occlusive events and microcirculation defects, are crucial for endocrine dysfunction in SCD patients. These endocrinopathies include diabetes mellitus, hypothyroidism, parathyroid dysfunction, gonadal and growth failure, osteoporosis, and adrenal insufficiency, affecting the quality of life of these patients. Thus, we aim to provide current knowledge and data about the epidemiology, pathogenesis, diagnosis, and management of endocrine disorders in β-thalassemia and SCD. We conducted a comprehensive review of the literature and examined the available data, mostly using the PubMed and Medline search engines for original articles. In the era of precision medicine, more studies investigating the potential role of genetic modifiers in the development of endocrinopathies in hemoglobinopathies are essential.
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Affiliation(s)
- Paschalis Evangelidis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Theodora-Maria Venou
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration General Hospital, 54642 Thessaloniki, Greece; (T.-M.V.); (E.V.)
| | | | - Efthymia Vlachaki
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration General Hospital, 54642 Thessaloniki, Greece; (T.-M.V.); (E.V.)
| | - Eleni Gavriilaki
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
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Kweka BV, Fredrick C, Kitilya B, Jeremiah K, Lyimo E, Filteau S, Rehman AM, Friis H, Olsen MF, Faurholt-Jepsen D, Krogh-Madsen R, PrayGod G. Association of sickle cell trait with β-cell dysfunction and physical activity in adults living with and without HIV in Tanzania. APMIS 2022; 130:230-239. [PMID: 35167170 PMCID: PMC9314065 DOI: 10.1111/apm.13214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022]
Abstract
This study aimed to investigate sickle cell trait (SCT) associations with physical activity, markers of insulin secretion and resistance, and glucose among people living with HIV infection (PLWH), both antiretroviral therapy (ART) naive and experienced, and HIV-uninfected adults. This was a cross-sectional study conducted in Mwanza, Northwestern Tanzania. We used data of 668 participants attained from two sub-studies of CICADA study. Mean age was 40 (SD 11.5) years, 402 (61.7%) were females and 157 (24.1%) had SCT. PLWH were 422 (64.7%), of these, 80 (18.9%) were on ART. People with SCT had higher risk of having an isolated β-cell dysfunction compared to those without SCT (RRR = 1.82, CI: 1.10, 3.01, p = 0.02). People with SCT but without HIV infection had lower average acceleration on the trunk longitudinal axis (ACCx) and higher level of self-reported physical activity. 30 min oral glucose tolerance test among PLWH on ART was higher in those with SCT compared to those without SCT. People with SCT are at higher risk of having β-cell dysfunction and those with SCT on ART are at more risk of developing diabetes. Future studies to investigate the interaction between SCT and HIV/ART on risk of diabetes should be considered.
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Affiliation(s)
- Belinda V Kweka
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Cyprian Fredrick
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Eric Lyimo
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrea M Rehman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Rikke Krogh-Madsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
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Babalola OA, Ogunkeyede A, Odetunde AB, Fasola F, Oni AA, Babalola CP, Falusi AG. Haematological indices of sickle cell patients with chronic leg ulcers on compression therapy. Afr J Lab Med 2020; 9:1037. [PMID: 33392050 PMCID: PMC7756931 DOI: 10.4102/ajlm.v9i1.1037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/23/2020] [Indexed: 11/01/2022] Open
Abstract
Background Recurrent chronic leg ulcers and its are morbidities associated with sickle cell anaemia (SCA). Compression therapy increases the rate of healing of these ulcers and also decreases the rate of recurrence. Objective This study evaluated the haematological parameters of patients with SCA and chronic leg ulcers placed on high compression bandaging to provide data for improved ulcer management and prevention. Methods Eighteen patients with SCA and chronic leg ulcers were recruited for treatment by compression therapy in Ibadan, Nigeria, from March to June 2015. Eighteen SCA patients with no history of chronic leg ulcers were age and sex matched and recruited as controls. Blood samples, wound biopsies and swabs were collected at different time points for full blood count, microbiology, culture and antimicrobial susceptibility tests. Haemoglobin variants were quantified by high performance liquid chromatography. Fasting blood sugar was tested for leg ulcer patients to determine diabetic status. Results Ulcers ranged from 0.5 cm2 to 416 cm2 (median: 38.4 cm2). Post-intervention ulcer size ranged from 0.0 cm2 to 272 cm2 (median: 18.6 cm2, p < 0.001); four ulcers completely healed. Compared to the control group, haematological indices at commencement of treatment were more severe in leg ulcer patients (p = 0.02). No patients with chronic leg ulcer was diabetic. Microorganisms isolated from the leg ulcers include Pseudomonas aeruginosa, Staphylococcus aureus, Proteus sp., Escherichia coli and Klebsiella oxytoca. Conclusion Measures to improve haematological parameters during leg ulcer treatment in SCA patients should be taken to aid wound healing.
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Affiliation(s)
- Oluwatoyin A Babalola
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodele Ogunkeyede
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Abayomi B Odetunde
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Foluke Fasola
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anthony A Oni
- Department of Medical Microbiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chinedum P Babalola
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Sickle Cell Hope Alive Foundation (SCHAF), Nigeria
| | - Adeyinka G Falusi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Sickle Cell Hope Alive Foundation (SCHAF), Nigeria
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4
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Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus. Blood Adv 2020; 3:3297-3306. [PMID: 31698459 DOI: 10.1182/bloodadvances.2019000838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/30/2019] [Indexed: 12/26/2022] Open
Abstract
Metformin was recently found to increase fetal hemoglobin, which is protective in sickle cell disease (SCD). We tested the hypothesis that, among adults with SCD and diabetes mellitus (DM), metformin use is associated with fewer adverse SCD clinical outcomes and lower health care utilization. This is a retrospective cohort study using the MarketScan Medicaid claims database for 2006 to 2016, comparing metformin users and nonusers. Patients on hydroxyurea, insulin, or iron chelation were excluded. Main outcomes included annual rates of all-cause inpatient encounters, all-cause emergency department (ED) encounters, inpatient and ED encounters with SCD codes, vaso-occlusive episodes (VOEs), strokes, acute chest syndrome (ACS), avascular necrosis (AVN), and gallstones. Of 457 adults (median age [interquartile range], 43 years [33-52 years]; 72% female), 142 (31%) were treated with metformin. Adjusted for age, sex, and Charlson Comorbidity Index, metformin users had significantly lower rate ratios of all-cause inpatient encounters (0.68; 95% confidence interval [CI], 0.52-0.88; P < .01), inpatient encounters with SCD codes (0.45; 95% CI, 0.30-0.66; P < .01), ED encounters with SCD codes (0.34; 95% CI, 0.21-0.54; P < .01), VOE (0.22; 95% CI, 0.12-0.41; P < .01), ACS (0.17; 95% CI, 0.05-0.60; P = .01), and AVN (0.30; 95% CI, 0.11-0.87; P = .03). A subgroup analysis of 54 enrollees preinitiation and postinitiation of metformin did not indicate significant changes in rates of clinical events. Metformin was associated with significantly fewer inpatient and ED SCD encounters in adults with SCD and DM; however, confounding of underlying SCD severity cannot be excluded.
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Zhou J, Han J, Nutescu EA, Galanter WL, Walton SM, Gordeuk VR, Saraf SL, Calip GS. Similar burden of type 2 diabetes among adult patients with sickle cell disease relative to African Americans in the U.S. population: a six-year population-based cohort analysis. Br J Haematol 2019; 185:116-127. [PMID: 30714090 DOI: 10.1111/bjh.15773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
Conflicting evidence exists on the epidemiology of type 2 diabetes mellitus (T2DM) among patients with sickle cell disease (SCD). This study measured the prevalence, incidence and clinical outcomes associated with T2DM in a large US population of commercially-insured adults aged ≥20 years with SCD between 2009 and 2014. Among 7070 patients with SCD, the mean age (median) was 39 (37) years and 60·8% were female. The standardized prevalence of T2DM among patients with SCD showed a modest increase, from 15·7% to 16·5% (P trend = 0·026), and was comparable to African-American respondents to the National Health and Nutrition Examination Survey (18·2%). Over 17 024 person-years, the crude incidence rate for T2DM was 25·4 per 1000 person-years. Incident T2DM was associated with comorbid hypertension (hazard ratio [HR] = 1·45, 95% confidence interval [CI] 1·14-1·83), and dyslipidaemia (HR = 1·43, 95%CI 1·04-1·96). Compared to SCD patients without T2DM, more SCD patients with T2DM had diagnoses of nephropathy (28·0% vs. 9·5%; P < 0·001), neuropathy (17·7% vs. 5·2%; P < 0·001) and stroke (24·1% vs. 9·2%; P < 0·001). Prevalence of T2DM in SCD patients is similar to the general African American population with an increasing trend in recent years. These trends support routine screening for T2DM in aging patients with SCD, especially those with comorbid hypertension and/or dyslipidaemia.
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Affiliation(s)
- Jifang Zhou
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jin Han
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA.,Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Edith A Nutescu
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - William L Galanter
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Department of Medicine, Section of Academic Internal Medicine & Geriatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Surrey M Walton
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Victor R Gordeuk
- Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Santosh L Saraf
- Division of Hematology & Oncology, Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA.,Division of Public Health Sciences, Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Prusty B, Soren T, Choudhury A, Biswal R, Pradhan DK, Thatoi PK. Sickle cell disease prevents diabetes mellitus occurrence: A hospital based cross-sectional study. J Family Med Prim Care 2019; 8:361-364. [PMID: 30984639 PMCID: PMC6436325 DOI: 10.4103/jfmpc.jfmpc_466_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sickle cell disease is the commonest inherited hemoglobinopathy. There are few reports point towards decrease incidence of diabetes mellitus in sickle cell disease patients. MATERIALS AND METHODS This cross-sectional study was conducted in VIMSAR, Burla, Odisha between Nov 2014 to Oct 2016. FBS and 2 hours OGTT reports of adult sickle cell disease patients were compared with the same reports from equal no of adult persons without sickle cell disease (controls) to found out any significant difference in prevalence of diabetes mellitus in sickle cell disease patients versus controls. RESULTS A total of 137 adult patients of sickle cell disease out of which males were 94 (68.61%) and females were 43 (31.38%) with an average age of (26.7 ± 10.9) years and an equal number of controls [males 87 (63.8%) and females 50 (36.5%)] with an average age of (47.6 ± 13.6) years were included in the study. We found diabetes mellitus in 2 (1.46%) out of 137 sickle cell disease patients with an average BMI 18.5 kg/m2 versus 12 (8.76%) in equal number of controls with an average BMI of 22.6 kg/m2. CONCLUSION This study concludes that prevalence of diabetes mellitus in sickle cell disease patients is significantly lower than non-sickle cell disease persons. This may be due to less longevity and low BMI in sickle cell disease patients.
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Affiliation(s)
- Biswaranjan Prusty
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Thakura Soren
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
| | - Anurag Choudhury
- Department of Medicine, SCB Medical College, Cuttack, Odisha, India
| | - Reshma Biswal
- Department of Dermatology, SCB Medical College, Cuttack, Odisha, India
| | - Dillip K. Pradhan
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
| | - Pravat K. Thatoi
- Department of Medicine, PRM Medical College, Baripada, Odisha, India
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Akinlade KS, Kumuyi AS, Rahamon SK, Olaniyi JA. Insulin Sensitivity, Inflammation, and Basal Metabolic Rate in Adults with Sickle Cell Anemia. Int J Appl Basic Med Res 2018; 8:106-110. [PMID: 29744323 PMCID: PMC5932917 DOI: 10.4103/ijabmr.ijabmr_96_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Chronic inflammation and elevated basal metabolic rate (BMR) are established features of sickle-cell anemia (SCA). However, there is little information on the possible impacts of these afore-mentioned features on glycemia and insulin sensitivity status of this group of people. Aim: This study aims to determine the insulin sensitivity status as well the effect of BMR on glycemia in adults with SCA in steady state. Materials and Methods: Fifty participants comprising 30 adults with SCA in steady state and 20 age- and gender-matched apparently healthy adults with hemoglobin genotype AA (HbAA) genotype that served as controls. Anthropometric and clinical indices were obtained using standard methods. After an overnight fast, fasting plasma glucose (FPG), and serum insulin levels were determined using the glucose oxidase method and ELISA, respectively. Indices of insulin sensitivity and β-cell function as well as BMR were appropriately calculated. Results: The mean fasting insulin resistance (IR) index, homeostatic model of assessment of IR (HOMA-IR) and of β-cell function (HOMA2-β%), and mean insulin level were significantly lower while the mean HOMA of insulin sensitivity (HOMA2-S%), quantitative insulin sensitivity check index, inverse of insulin sensitivity (1/FI), glucose-insulin ratio, C-reactive protein (CRP), and BMR was significantly higher in patients with SCA compared with the controls. The mean FPG and insulin levels and the mean values of indices of insulin sensitivity and secretion were not significantly different in SCA patients with elevated BMR compared with SCA patients with lower BMR. In addition, BMR had no significant correlation with FPG and HOMA-IR in patients with SCA. Conclusion: Despite the established chronic inflammation in SCA patients in steady state, they seem to have better insulin sensitivity status but impaired β-cell activity when compared with adults with HbAA. Furthermore, BMR does not have any pronounced effect on glycemic and insulin sensitivity status in SCA patients in steady state.
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Affiliation(s)
- Kehinde Sola Akinlade
- Department of Chemical Pathology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Samuel Kumuyi
- Department of Chemical Pathology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Sheu Kadiri Rahamon
- Department of Biochemistry, College of Medical Sciences, Edo University, Iyamho, Edo State, Nigeria
| | - John Ayodele Olaniyi
- Department of Haematology, University College Hospital, University of Ibadan, Ibadan, Nigeria
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Zhang X, Zhang W, Saraf SL, Nouraie M, Han J, Gowhari M, Hassan J, Miasnikova G, Sergueeva A, Nekhai S, Kittles R, Machado RF, Garcia JGN, Gladwin MT, Steinberg MH, Sebastiani P, McClain DA, Gordeuk VR. Genetic polymorphism of APOB is associated with diabetes mellitus in sickle cell disease. Hum Genet 2015; 134:895-904. [PMID: 26025476 PMCID: PMC4607040 DOI: 10.1007/s00439-015-1572-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/22/2015] [Indexed: 02/02/2023]
Abstract
Environmental variations have strong influences in the etiology of type 2 diabetes mellitus. In this study, we investigated the genetic basis of diabetes in patients with sickle cell disease (SCD), a Mendelian disorder accompanied by distinct physiological conditions of hypoxia and hyperactive erythropoiesis. Compared to the general African American population, the prevalence of diabetes as assessed in two SCD cohorts of 856 adults was low, but it markedly increased with older age and overweight. Meta-analyses of over 5 million single-nucleotide polymorphisms (SNPs) in the two SCD cohorts identified a SNP, rs59014890, the C allele of which associated with diabetes risk at P = 3.2 × 10(-8) and, surprisingly, associated with decreased APOB expression in peripheral blood mononuclear cells (PBMCs). The risk allele of the APOB polymorphism was associated with overweight in 181 SCD adolescents, with diabetes risk in 592 overweight, non-SCD African Americans ≥ 45 years of age, and with elevated plasma lipid concentrations in general populations. In addition, lower expression level of APOB in PBMCs was associated with higher values for percent hemoglobin A1C and serum total cholesterol and triglyceride concentrations in patients with Chuvash polycythemia, a congenital disease with elevated hypoxic responses and increased erythropoiesis at normoxia. Our study reveals a novel, environment-specific genetic polymorphism that may affect key metabolic pathways contributing to diabetes in SCD.
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Affiliation(s)
- Xu Zhang
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Santosh L. Saraf
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mehdi Nouraie
- Center for Sickle Cell Disease, Howard University, Washington, DC
| | - Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Michel Gowhari
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Johara Hassan
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | | | | | - Sergei Nekhai
- Center for Sickle Cell Disease, Howard University, Washington, DC
| | - Rick Kittles
- University of Arizona, College of Medicine, Tucson, AZ
| | - Roberto F. Machado
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Illinois at Chicago, Chicago, IL
| | | | - Mark T. Gladwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA
| | | | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Donald A. McClain
- Department of Internal Medicine, Wake Forest University School of Medicine and VA Medical Center, Winston Salem, NC
| | - Victor R. Gordeuk
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
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Mohamed AA, Al-Qurashi F, Whitford DL. Does Sickle Cell Disease Protect Against Diabetes Mellitus?: Cross-sectional study. Sultan Qaboos Univ Med J 2015; 15:e116-e119. [PMID: 25685370 PMCID: PMC4318591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/04/2014] [Accepted: 08/27/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES The co-existence of diabetes mellitus (DM) and sickle cell disease (SCD) is rare. This study aimed to explore whether SCD patients have the same DM prevalence as the general population in a country with a high prevalence of DM. METHODS This cross-sectional study included all SCD adult patients admitted to Salmaniya Medical Complex, Bahrain, between 2003 and 2010 (n = 2,204). A random sample (n = 520) was taken to establish the prevalence of DM. Laboratory records were examined to determine the presence of DM. RESULTS There were 376 SCD patients with complete records; of these, 24 (6.4%) had DM. The age- and sex-standardised prevalence of DM was 8.3%. CONCLUSION While the prevalence of DM in SCD patients in Bahrain was high, it was lower than expected in this population. SCD may have a protective effect towards DM development. However, the impact of these two conditions on vascular diseases suggest a need for screening and aggressive treatment in this population.
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Affiliation(s)
- Ali A. Mohamed
- School of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Busaiteen, Bahrain
| | - Fathia Al-Qurashi
- Department of Haematology, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, UK
| | - David L. Whitford
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Busaiteen, Bahrain
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10
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Shoar Z, Rezvani G, De Luca F. Type 1 diabetes mellitus in a patient with homozygous sickle cell anemia. J Pediatr Endocrinol Metab 2013; 26:1205-7. [PMID: 23813357 DOI: 10.1515/jpem-2012-0412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/16/2013] [Indexed: 11/15/2022]
Abstract
In children with sickle cell disease, reports of type 1 diabetes mellitus (T1D) are extremely rare. Several studies failed to show the co-existence of the two conditions. In the few cases reported, the diagnosis has been made solely based on the clinical presentation. Here we report the case of an adolescent with sickle cell anemia who presented with hyperglycemia and positive T1D-specific auto-antibodies.
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11
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Jans SMPJ, de Jonge A, Lagro-Janssen ALM. Maternal and perinatal outcomes amongst haemoglobinopathy carriers: a systematic review. Int J Clin Pract 2010; 64:1688-98. [PMID: 20946275 DOI: 10.1111/j.1742-1241.2010.02451.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
With the introduction of screening programmes for haemoglobinopathies (HbP), more women will be aware of their HbP status. The genetic risk for women who are carriers of HbP is well known. However, midwives and obstetricians need to know whether there are other risks involved in the pregnancies of women who are carriers of HbP. The objective of this study was to investigate the hypothesis that being a carrier of HbP has no consequences for the health of pregnant women and the outcome of their pregnancies. A systematic search was carried out until August 2008 in the Cochrane Library, Medline, EMBASE and CINAHL databases. All references were inspected to identify further studies. The authors of key publications were contacted for any unpublished research. Selection of studies was made on the basis of the following criteria: Cohort and case-control studies, pregnant women with a singleton pregnancy, exposure: HbAS or thalassaemia minor and the following outcomes: urinary tract infection (UTI), anaemia, (pre-)eclampsia, gestational diabetes, premature labour, low birth weight, intrauterine growth retardation, miscarriage, neonatal death, low Apgar score, neural tube defects. Quality assessment and data extraction were carried out by two researchers. A total of 780 subjects were identified of which nine were included in the study. A protective effect of sickle cell trait was found for premature birth, low Apgar score and perinatal mortality rate. No significant effect was found for low birth weight, growth retardation, UTI or high blood pressure. The risk of anaemia and bacteriuria was increased. In conclusion, the risks amongst pregnant HbP carriers are low. Midwives and obstetricians need to be aware of the risk of anaemia and UTI.
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Affiliation(s)
- S M P J Jans
- Department of Primary Care and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
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12
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Koduri PR, Agbemadzo B, Nathan S. Hemoglobin S-C disease revisited: clinical study of 106 adults. Am J Hematol 2001; 68:298-300. [PMID: 11754423 DOI: 10.1002/ajh.10001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe the clinical features of S-C hemoglobin disease in 106 adults seen during the years 1972-2000 and followed for a mean period of 6.8 years (range 1-27 years). The median age of the patients was 50 years. Common clinical features were pain crisis (65%), avascular necrosis of the hip (23%), proliferative sickle retinopathy (34%), and splenic infarction/splenic sequestration syndrome (19%). Acute splenic sequestration crisis occurred in 10 patients and was the presenting feature in two. Obesity (19.8%), essential hypertension (20.7%), and type-2 diabetes mellitus (10.3%) were common. The frequent occurrence of these co-morbidities among patients with hemoglobin S-C disease has not been reported previously.
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Affiliation(s)
- P R Koduri
- The Department of Medicine, Division of Hematology-Oncology, Cook County Hospital, Chicago, Illinois, USA
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Culberson DE, Manci EA, Shah AK, Haynes J, Ballas SK, Pegelow C, Vichinsky E. Nesidioblastosis in sickle cell disease. PEDIATRIC PATHOLOGY & MOLECULAR MEDICINE 2001; 20:155-65. [PMID: 12673839 DOI: 10.1080/15513810109168608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although the endocrine pancreas appears to play an important role in the pathophysiology of sickle cell disease, very little is known about the morphologic changes in this tissue. Our study was initiated to delineate the microscopic features of the endocrine pancreas in a large autopsy series of sickle cell hemoglobinopathies. From more than 650 cases archived at the Centralized Pathology Unit for Sickle Cell Disease (Mobile, AL), 224 autopsy cases were identified for review of clinical and gross autopsy findings and/or for microscopic studies, including histochemical stains (trichrome, reticulin, iron), and immunohistochemical stains (insulin, glucagon, somatostatin, and pancreatic polypeptide). The gross examinations were recorded as unremarkable in 65% of the autopsies. In childhood and adolescence (< or = 18 years), pancreas weights (50.76 +/- 5.16SE gm) were significantly greater (p < 0.0001) than age-matched controls (30.42 +/- 3.59SE gm). In adulthood, pancreas weights (108.34 +/- 5.29SE gm) were not significantly different from controls (110 gm). Microscopic findings included vascular congestion (48%), edema (65%), siderosis (31%), and nesidioblastosis (76%), which included islet cell dispersion (53%), hyperplasia (23%), and hypertrophy (25%). Analysis by age groups suggested that islet cell dispersion/hyperplasia persists unchanged, whereas diameters of compact islets tend to increase with age. These findings may be related to local tissue hypoxia and/or increased metabolic energy needs in sickle cell disease.
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Affiliation(s)
- D E Culberson
- Centralized Pathology Unit for Sickle Cell Disease, University of South Alabama, Mobile, Alabama, USA
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