一项关于输血依赖型地中海贫血（TDT）患者年度口服葡萄糖耐量试验（OGTT）筛查依从性的多中心ICET-A调查——专家临床医生对影响依从性的因素及优化依从性替代策略的看法。
A Multicenter ICET-A Survey on Adherence to Annual Oral Glucose Tolerance Test (OGTT) Screening in Transfusion-Dependent Thalassemia (TDT) Patients - The Expert Clinicians' Opinion on Factors Influencing the Adherence and on Alternative Strategies for Adherence Optimization.
作者信息
de Sanctis Vincenzo, Canatan Duran, Daar Shahina, Kattamis Christos, Banchev Atanas, Modeva Iskra, Savvidou Irene, Christou Soteroula, Kattamis Antonis, Delaporta Polyxeni, Kostaridou-Nikolopoulou Stavroula, Karimi Mehran, Saki Forough, Faranoush Mohammad, Campisi Saveria, Fortugno Carmelo, Gigliotti Francesco, Wali Yasser, Al Yaarubi Saif, Yassin Mohamed A, Soliman Ashraf T, Kottahachchi Dulani, Kurtoğlu Erdal, Gorar Suheyla, Turkkahraman Doga, Unal Sule, Oymak Yesim, Ay Tuncel Defne, Karakas Zeynep, Gül Nurdan, Yildiz Melek, Elhakim Ihab, Tzoulis Ploutarchos
机构信息
Coordinator of ICET-A Network (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine), Ferrara, Italy.
Antalya Bilim University and Antalya Genetic Diseases Assessment Center, Antalya, Turkey.
出版信息
Mediterr J Hematol Infect Dis. 2025 Jan 1;17(1):e2025008. doi: 10.4084/MJHID.2025.008. eCollection 2025.
BACKGROUND
Current guidelines for screening glucose dysregulation (GD) in patients with transfusion-dependent thalassemia (TDT) recommend an annual 2-hour oral glucose tolerance test (OGTT) starting at the age of 10 years.
OBJECTIVE
Assessment of adherence to OGTT screening in patients with TDT.
METHODS
A questionnaire was distributed to 18 Thalassemia Centers in 10 different countries, targeting factors influencing adherence to annual OGTT screening in specialized multidisciplinary pediatric and adult TDT units and identifying strategies to improve adherence to OGTT in TDT patients.
RESULTS
The mean reported percentage of all types of GD across 16 of the 18 centers at the last OGTT assessment was 32.0%, while the mean percentage for thalassemia-related diabetes mellitus (Th-RDM) was 12.2 ± 9.7% (range: 0%-41%; median: 13.2 %) in all participating centers. Notably, a high percentage of suboptimal or poor adherence to annual OGTT screening (mean 41.3%; range 10-90%) was reported by 17/18 centers. Poor adherence to annual OGTT among eligible patients was multifactorial and related to both patients and the healthcare system barriers. The most commonly suggested actions by hematologists and endocrinologists for improving the adherence to OGTT were flexibility in timing, easy approach to test location, improved collaboration among team members, and persistent reminding.
CONCLUSIONS
Young adult patients with TDT are at high risk for developing GD and Th-RDM. Thus, annual screening with a 2-hour OGTT is recommended. Nevertheless, several patient barriers are associated with low adherence to annual OGTT. It is desirable to develop intensive initiatives to improve the screening rate for GD, while studies are warranted to update the current guidelines in TDT patients with low-risk factors for GD and for countries with low-resource settings.
背景
目前针对输血依赖型地中海贫血（TDT）患者葡萄糖调节异常（GD）筛查的指南建议，从10岁起每年进行一次2小时口服葡萄糖耐量试验（OGTT）。
目的
评估TDT患者对OGTT筛查的依从性。
方法
向10个不同国家的18个地中海贫血中心发放了一份问卷，针对影响专业多学科儿科和成人TDT单位年度OGTT筛查依从性的因素，并确定提高TDT患者对OGTT依从性的策略。
结果
在18个中心中的16个中心的最后一次OGTT评估中，所有类型GD的平均报告百分比为32.0%，而在所有参与中心中，地中海贫血相关糖尿病（Th-RDM）的平均百分比为12.2±9.7%（范围：0%-41%；中位数：13.2%）。值得注意的是，17/18个中心报告称，对年度OGTT筛查的依从性次优或较差的比例很高（平均41.3%；范围10%-90%）。符合条件的患者对年度OGTT依从性差是多因素的，与患者和医疗系统障碍都有关。血液科医生和内分泌科医生提出的提高对OGTT依从性的最常见行动是时间安排灵活、检测地点方便前往、团队成员之间加强协作以及持续提醒。
结论
TDT青年患者发生GD和Th-RDM的风险很高。因此，建议每年进行一次2小时OGTT筛查。然而，一些患者障碍与年度OGTT依从性低有关。需要开展强化举措来提高GD的筛查率，同时有必要开展研究以更新目前针对GD低风险因素的TDT患者以及资源匮乏国家的TDT患者的指南。
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