Quisisana Hospital, Ferrara.
Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar and Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt.
Acta Biomed. 2021 Sep 2;92(4):e2021322. doi: 10.23750/abm.v92i4.11105.
Subjects with normal glucose tolerance (NGT) but 1-hour post-load plasma glucose (1-h OGTT) ≥ 155 mg/dl (8.6 mmol/L; H-NGT) have an increased risk for developing Type 2 diabetes mellitus (T2DM), determining a new risk factor category with deeper metabolic impairment. The aim of this study was to evaluate the H-NGT as a diagnostic predictor of future dysglycemia in β-transfusion dependent thalassemia (β-TDT). Indices of insulin secretion and insulin sensitivity derived at baseline from OGTTs, were also reviewed.
OGTT and indices of insulin secretion and insulin sensitivity, derived at baseline during OGTT, in 17 β-TDT with H-NGT and 29 β-TDT with normal OGTT (NGT) and without H-NGT followed for 12 years were studied.
H-NGT was associated with decreased insulin sensitivity and progressive deterioration of glucose tolerance. At baseline, serum ferritin and serum alanine aminotransferase (ALT) levels were higher in patients with H-NGT compared to patients with NGT. A strong correlation was observed between ALT and 1-hour plasma glucose value during OGTT in the total group of 36 patients . Compliance to iron chelation therapy was poor in β-TDT patients with H-NGT. An inverse correlation was found between 1-hour plasma glucose value during OGTT and insulin secretion-sensitivity index-2 (ISSI-2) (r: -0.3298; p: 0.025), between ISSI-2 and ALT (r: -0.3262; p: 0.027), and between 1-hour plasma glucose value and ISSI-2 (r: -0.537; p: 0.005) in the whole group of β-TDT patients enrolled in our study.
This retrospective study displayed that finding an isolated high 1-hour post-load glucose level (≥155 mg/dL; H-NGT) during the OGTT may serve as a simple biomarker to detect high-risk patients, with chronic liver disease and/or iron overload, who need periodic glycemic surveillance. Measuring the ISSI 2 represented another valuable predictive marker in the assessment of glycemia in these patients.
具有正常糖耐量（NGT）但 1 小时餐后血糖（1-h OGTT）≥155mg/dl（8.6mmol/L；H-NGT）的受试者发生 2 型糖尿病（T2DM）的风险增加，这确定了一个具有更深代谢损害的新风险因素类别。本研究的目的是评估 H-NGT 作为β-转铁蛋白依赖地中海贫血（β-TDT）未来糖代谢异常的诊断预测指标。还回顾了 OGTT 基线时得出的胰岛素分泌和胰岛素敏感性指数。
对 17 例 H-NGT 的β-TDT 和 29 例正常 OGTT（NGT）且无 H-NGT 的β-TDT 进行了研究，这些患者在 12 年内进行了 OGTT 并评估了 OGTT 基线时的胰岛素分泌和胰岛素敏感性指数。
H-NGT 与胰岛素敏感性降低和葡萄糖耐量逐渐恶化有关。在基线时，与 NGT 患者相比，H-NGT 患者的血清铁蛋白和血清丙氨酸氨基转移酶（ALT）水平更高。在 36 例患者的总组中，观察到 ALT 与 OGTT 中 1 小时血浆葡萄糖值之间存在很强的相关性。H-NGT 的β-TDT 患者对铁螯合治疗的依从性较差。在我们研究的所有β-TDT 患者中，OGTT 中 1 小时血浆葡萄糖值与胰岛素分泌-敏感性指数-2（ISSI-2）呈负相关（r：-0.3298；p：0.025），ISSI-2 与 ALT 呈负相关（r：-0.3262；p：0.027），OGTT 中 1 小时血浆葡萄糖值与 ISSI-2 呈负相关（r：-0.537；p：0.005）。
这项回顾性研究表明，在 OGTT 中发现孤立的高 1 小时餐后血糖水平（≥155mg/dL；H-NGT）可作为一种简单的生物标志物，以发现患有慢性肝病和/或铁过载的高危患者，需要定期进行血糖监测。测量 ISSI 2 是评估这些患者血糖的另一个有价值的预测标志物。
