Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt.
Department of Clinical Pathology, National Liver Institute, Shebin El-Kom, Egypt.
Pediatr Res. 2024 Oct;96(5):1292-1298. doi: 10.1038/s41390-024-03146-y. Epub 2024 Apr 4.
Beta-thalassemia major (β-TM) patients are more likely to experience blood glucose intolerance and to date; the blood markers that could evaluate this are debatable. So, this study aimed to assess the roles of glycated hemoglobin A1c (HbA1c) and fructosamine in evaluating glucose intolerance in children with β-TM and figuring out role of insulin resistance in these patients.
One hundred children diagnosed with β-TM and 100 age and sex-matched controls were enrolled. Fasting plasma glucose (FPG), 2-h post-prandial blood glucose (2-h PG), HbA1c, fructosamine, fasting insulin level (FINS), insulin resistance index (HOMA-IR), and insulin sensitivity index (HOMA-IS) were evaluated.
FPG and 2-h PG revealed glucose intolerance in 51 patients (51%), 19 of them had diabetes mellitus. HbA1c, fructosamine, FINS, and HOMA-IR showed a high statistically significant increase in patients compared to controls, (P < 0.001). Results revealed fructosamine was more specific in detecting prediabetes state and more sensitive in identifying diabetes mellitus in our patients when compared to HbA1c.
Despite controversies on HbA1c in children with β-TM, it is still valuable in glucose intolerance detection. Fructosamine showed more sensitivity and specificity. Furthermore, insulin resistance was prevalent in children with β-TM highlighting the necessity of regular glycemic state evaluation.
Glucose intolerance is a common complication in beta thalassemia patients. Conflicting data was reported about the role of HbA1c and fructosamine in evaluating glucose intolerance in thalassemic patients. Fructosamine does not yet have a threshold that may be used to distinguish between patients who have diabetes mellitus and those who do not. Fructosamine was more specific in detecting blood glucose intolerance compared to HbA1c and was more sensitive for diagnosing diabetes mellitus. Insulin resistance was common in patients with beta-thalassemia and often present before the onset of overt diabetes.
重型β地中海贫血（β-TM）患者更易出现血糖不耐受，迄今为止，能够评估这一点的血液标志物仍存在争议。因此，本研究旨在评估糖化血红蛋白 A1c（HbA1c）和果糖胺在评估β-TM 儿童葡萄糖耐量中的作用，并确定这些患者胰岛素抵抗的作用。
纳入 100 例确诊为β-TM 的儿童和 100 名年龄和性别匹配的对照组。评估空腹血糖（FPG）、餐后 2 小时血糖（2-h PG）、HbA1c、果糖胺、空腹胰岛素水平（FINS）、胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（HOMA-IS）。
51 例（51%）患者 FPG 和 2-h PG 显示葡萄糖耐量受损，其中 19 例患有糖尿病。与对照组相比，患者的 HbA1c、果糖胺、FINS 和 HOMA-IR 均显著升高，差异有统计学意义（P<0.001）。结果显示，与 HbA1c 相比，果糖胺在检测糖尿病前期状态方面更具特异性，在识别本患者的糖尿病方面更具敏感性。
尽管关于β-TM 儿童的 HbA1c 存在争议，但它仍然在检测葡萄糖耐量方面具有价值。果糖胺显示出更高的敏感性和特异性。此外，β-TM 儿童中普遍存在胰岛素抵抗，这突出表明需要定期评估血糖状态。
葡萄糖耐量受损是β地中海贫血患者的常见并发症。关于 HbA1c 和果糖胺在评估地中海贫血患者葡萄糖耐量中的作用，已有相互矛盾的数据报道。果糖胺目前尚无一个可能用于区分糖尿病患者和非糖尿病患者的阈值。与 HbA1c 相比，果糖胺在检测血糖耐量方面更具特异性，在诊断糖尿病方面更具敏感性。β-地中海贫血患者中胰岛素抵抗很常见，且常在明显糖尿病发病前出现。
