Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens , "Aghia Sophia" Children Hospital, Athens Greece.
Aghia Sophia Children's Hospital, Athens, Greece.
Acta Biomed. 2021 Sep 2;92(4):e2021265. doi: 10.23750/abm.v92i4.11144.
Dysregulation of glucose metabolism is a common complication of transfusions in Transfusion Dependent Thalassemia (TDT) patients. For early diagnosis of glucose disturbances, screening is recommended. The age of starting and the type of screening vary; the more common methods are assessment of RPG, FPG, 2h PG and 2 hours OGTT. The combined assessment of glucose tolerance and insulin response during OGTT is rarely recommended. The main objective of the study is the evaluation of simultaneous assessment of Glucose Tolerance (GT) and Insulin Response (IR) during OGTT in patients with TDT.
43 TDT patients aged 12-28years, without clinical evidence of glucose disturbances, were randomly selected for the study. The 2-hour OGTT in 30 minutes intervals was applied. Plasma glucose and insulin were assessed in all samples using routine laboratory methods.
Of 43 patients 31(72%) had Normal GT; of them 9 (29%) had normal insulin response (NIR), 14 (45%) high IR and 8(26%) delayed peak IR. Delayed peak IR was found in 8 of the 9 patients with Impaired GT and in 2 of the 3 with diabetic GT. Deficient IR (hypoinsulinemia) was found in two patients.
Simultaneous assessment of GT and IR during OGTT in TDT patients, seems to be a most sensitive and creditable screening test for early diagnosis of glucose disturbances. High IR and delayed peak IR in normoglycemic patients are valuable indices for diagnosis of the pre-diabetic state that precede the development of glucose disturbances in TDT patients and start proper follow and management.
葡萄糖代谢失调是输血依赖型地中海贫血（TDT）患者输血的常见并发症。为了早期诊断葡萄糖紊乱，建议进行筛查。开始筛查的年龄和筛查的类型各不相同；更常见的方法是评估 RPG、FPG、2hPG 和 2 小时 OGTT。OGTT 期间联合评估葡萄糖耐量和胰岛素反应很少被推荐。本研究的主要目的是评估在 TDT 患者中 OGTT 期间同时评估葡萄糖耐量（GT）和胰岛素反应（IR）。
随机选择 43 名年龄在 12-28 岁、无葡萄糖紊乱临床证据的 TDT 患者进行研究。在 30 分钟间隔内进行 2 小时 OGTT。使用常规实验室方法评估所有样本中的血浆葡萄糖和胰岛素。
43 名患者中，31 名（72%）GT 正常；其中 9 名（29%）胰岛素反应正常（NIR），14 名（45%）高 IR，8 名（26%）胰岛素峰值延迟。在 8 名 GT 受损的患者和 3 名糖尿病 GT 的患者中发现了胰岛素峰值延迟。两名患者存在胰岛素抵抗不足（低胰岛素血症）。
在 TDT 患者中 OGTT 期间同时评估 GT 和 IR，似乎是一种最敏感和可信的筛查试验，可早期诊断葡萄糖紊乱。在血糖正常的患者中，高 IR 和胰岛素峰值延迟是诊断糖尿病前期的有价值指标，糖尿病前期先于 TDT 患者葡萄糖紊乱的发生，并开始适当的随访和管理。
