Diabetes Mellitus in Thalassaemia Major Patients: A Report from the Southeast of Iran

How Age, Sex and Transfusion Affects the Incidence of Endocrine and Bone Density Disorders in Major Thalassemic Patients

Background

Beta-thalassemia major patients frequently have endocrinopathies. We tried to determine relation between demographic and transfusion factor and endocrinopathies.

Methods

Major beta-thalassemia patients (n=114 cases), 3-38 yr of age, entered this study. Female to male ratio was 51/63. Children (less than 20 yr) formed 57% of participants. Information about bone mineral density (BMD) and hormonal and biochemistry blood evaluation including fasting blood sugar (FBS), ferritin, triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), testosterone (males), and estradiol (females) entered data sheet.

Results

Sex and ferritin level showed no significant correlation with above disorders. Age significantly correlated to short stature, diabetes, low BMD at femur and neck (P, 0.031, 0.008, 0.009 and <0.001, respectively) . The risk of short stature had increased in 12 yr and older patients 7.71 times than younger patients (P= 0.008). The risk of diabetes had increased in 35 yr and older patients 26.25 times than younger patients (P= 0.03). The risk of Z-score ≤ -2 in femoral region has increased in 19 yr and older patients 5.84 times than younger patients (P= 0.002). The risk of Z-score ≤ -2 in spinal region has increased in 14 yr and older patients 17 times than younger patients (P= 0.007).

Conclusion

The main factor related with endocrinopathies was age. The correlation between age and short stature, diabetes and low BMD was positive. Therefore, we recommend early monitoring of thalassemia patients (in their late childhood and early teenage) for these complications.

Serum Ferritin Levels and Other Associated Parameters with Diabetes Mellitus in Adult Patients Suffering from Beta Thalassemia Major

Background

Although beta thalassemia major (BTM) patients are properly treated with blood transfusions in accompany with iron chelation therapy, they suffer from complications, such as diabetes mellitus (DM).

Purpose

The purpose was to detect the critical serum ferritin level and other parameters correlated with DM among adult BTM patients. Also, it was to study whether each of these parameters is associated with a certain period of age.

Patients and Methods

This study included 200 adult BTM patients. A cross-sectional study was carried out. Patients clinical and laboratory variables, such as ferritin levels, and fasting blood glucose (FBS) were extracted from medical records at Zagazig University Hospital, Egypt. Liver and cardiac iron contents were assessed using MRI T2* methods. Statistical analysis was performed using IBM SPSS V26.0 software package.

Results

The overall frequency of DM over the total sample equals 6.5%. There were no impaired fasting glucose (IFG) in the medical records. Statistical significance between serum ferritin and DM was (P = 0.014). The serum ferritin 2500 ng/mL with age group (27-<32) years-old were risk factors. The distributions of DM according to BMI were (3.5%) of class overweight. Significant association between DM and BMI was (r = 0.357, P < 0.001). Liver MRI T2* has significant correlation with serum ferritin, but cardiac MRI T2* was poorly correlated. Association between liver and cardiac MRI T2* was not found.

Conclusion

Age group (27-<32) years-old and ferritin >2500 ng/mL should be properly treated immediately. The serum ferritin and BMI of class "overweight" were risk factors for DM. Factors such as diet should be followed. Serum ferritin can be used for estimating liver iron content for economic factors. But cardiac MRI T2* must be performed for evaluating cardiac iron accurately.

Glycemic Abnormalities Assessment on Children and Adolescents with Beta-Thalassemia Major

Background Iron overloading in beta-thalassemia major individuals can cause organ damage. Iron excess can cause endocrine problems, including diabetes. Diabetes mellitus in patients with beta-thalassemia major represents a major concern, especially in children and adolescents. Aim To assess glycemic abnormalities in children and adolescents with beta-thalassemia major. Methods This cross-sectional study included beta-thalassemia major subjects with no previous diabetes mellitus history and routinely obtained blood transfusion. Laboratory investigations on the fasting insulin and blood glucose levels, 2 h postprandial plasma glucose, fasting insulin, and serum ferritin levels were conducted. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for assessing insulin resistance. Statistically, a significant correlation was obtained if the p-value was <0.05. Results This research consisted of 56 beta-thalassemia major children. The mean age of the subjects was 9.46 (2-18) years old. At diagnosis, the mean age was 40 (3-180) months old. We found a significant correlation between serum ferritin and ages, body weight, height, diagnosis age, and blood volume per transfusion of the included subjects. Nevertheless, there was no significant correlation between serum ferritin with glycemic parameters, including fasting blood glucose, 2 h postprandial plasma glucose, fasting insulin levels, and HOMA-IR found with a p-value >0.05. Conclusions A significant correlation was identified between age at diagnosis and volume of blood per transfusion with serum ferritin levels. However, there was no significant correlation between serum ferritin levels with glycemic status.