Barton James C, Acton Ronald T
Southern Iron Disorders Center, Birmingham, AL 35209, USA; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Southern Iron Disorders Center, Birmingham, AL 35209, USA; Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
J Diabetes Res. 2017;2017:9826930. doi: 10.1155/2017/9826930. Epub 2017 Feb 26.
Diabetes in whites of European descent with hemochromatosis was first attributed to pancreatic siderosis. Later observations revealed that the pathogenesis of diabetes in hemochromatosis is multifactorial and its clinical manifestations are heterogeneous. Increased type 2 diabetes risk in hemochromatosis is associated with one or more factors, including abnormal iron homeostasis and iron overload, decreased insulin secretion, cirrhosis, diabetes in first-degree relatives, increased body mass index, insulin resistance, and metabolic syndrome. In p.C282Y homozygotes, serum ferritin, usually elevated at hemochromatosis diagnosis, largely reflects body iron stores but not diabetes risk. In persons with diabetes type 2 without hemochromatosis diagnoses, serum ferritin levels are higher than those of persons without diabetes, but most values are within the reference range. Phlebotomy therapy to achieve iron depletion does not improve diabetes control in all persons with hemochromatosis. The prevalence of type 2 diabetes diagnosed today in whites of European descent with and without hemochromatosis is similar. Routine iron phenotyping or genotyping of patients with type 2 diabetes is not recommended. Herein, we review diabetes in hemochromatosis and the role of iron in diabetes pathogenesis in whites of European descent with and without hemochromatosis.
欧洲血统且患有血色素沉着症的白人中的糖尿病最初被认为是由胰腺铁沉积所致。后来的观察表明，血色素沉着症中糖尿病的发病机制是多因素的，其临床表现具有异质性。血色素沉着症中2型糖尿病风险增加与一个或多个因素相关，包括铁稳态异常和铁过载、胰岛素分泌减少、肝硬化、一级亲属患糖尿病、体重指数增加、胰岛素抵抗和代谢综合征。在p.C282Y纯合子中，血清铁蛋白在血色素沉着症诊断时通常升高，很大程度上反映身体铁储存，但并非糖尿病风险。在未诊断出血色素沉着症的2型糖尿病患者中，血清铁蛋白水平高于无糖尿病者，但大多数值在参考范围内。旨在实现铁耗竭的放血疗法并不能改善所有血色素沉着症患者的糖尿病控制情况。如今，诊断出患有和未患有血色素沉着症的欧洲血统白人中2型糖尿病的患病率相似。不建议对2型糖尿病患者进行常规铁表型分析或基因分型。在此，我们综述了血色素沉着症中的糖尿病以及铁在患有和未患有血色素沉着症的欧洲血统白人糖尿病发病机制中的作用。
