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Liver iron concentration is an independent risk factor for the prediabetic state in β-thalassemia patients

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Background

Beta-thalassemia major (β-TM) comprises a group of inherited blood disorders characterized by the reduced synthesis of β-globin chains. Iron overload following blood transfusion can affect major tissues involved in glucose metabolism, leading to different glucose metabolic disorders in these patients. The aim of the present study was to compare glucose metabolism and iron overload indices in β-TM patients with prediabetic and normoglycemic states.

Methods

This analytical study was performed on 49 patients with β-TM (age > 18 years), receiving regular blood transfusions. The fasting plasma glucose (FPG) and glucose tolerance tests indicated 32 normoglycemic and 17 prediabetic cases. The serum levels of C-peptide, fructosamine, fasting serum insulin, and serum ferritin were measured. In addition, T2*-weighted magnetic resonance imaging (MRI) of the heart and liver was carried out. Glycemic metabolism indices, including quantitative insulin sensitivity check index (QUICKI) and homeostatic model assessment for insulin resistance (HOMA-IR), were also calculated.

Results

The HOMA-IR score was significantly higher, while the QUICKI score was significantly lower in prediabetic patients, compared to normoglycemic patients (median [IR], 2.59 [2.19] vs. 1.46 [1.03], p = 0.007; mean ± SD, 0.34 ± 0.03 vs. 0.37 ± 0.04, p = 0.01). On the other hand, β-cell function was not significantly different between the groups. The liver iron concentration (LIC) at a cutoff point of 5.82 mg/g dry weight showed 93% sensitivity and 70% specificity for differentiation of prediabetic and normoglycemic states (AUC, 0.81 [95% CI, 0.65–0.95]; p = 0.002).

Conclusion

Based on the findings, HOMA-IR and QUICKI can be applied as useful glycemic metabolism indices for predicting prediabetic and normoglycemic states among β-TM patients. Also, LIC was an independent risk factor for the prediabetic state.

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Acknowledgments

We would like to thank β-TM patients, as well as the TRC staff, for their sincere cooperation. This study was extracted from a thesis in pediatrics. We would also like to thank the Research Deputy of Mazandaran University of Medical Sciences (Sari, Iran) for the financial support and the University Ethics Committee for accepting our proposal.

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Authors and Affiliations

  1. Department of Pediatrics, Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

    Mehrnoush Kosaryan

  2. Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

    Malihe Rahimi

  3. Department of Pediatrics, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

    Daniel Zamanfar

  4. Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Science, Sari, Mazandaran, Iran

    Hadi Darvishi-Khezri

Authors
  1. Mehrnoush Kosaryan
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Correspondence to Hadi Darvishi-Khezri.

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The study conformed to the Declaration of Helsinki principles.

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All subjects gave informed consent and were informed of their ability to discontinue participation at any time.

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Appendix. Interpretation and categorization of cardiac and liver MRI

Appendix. Interpretation and categorization of cardiac and liver MRI

Table 6 Cardiac MRI
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Table 7 Liver MRI
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Kosaryan, M., Rahimi, M., Zamanfar, D. et al. Liver iron concentration is an independent risk factor for the prediabetic state in β-thalassemia patients. Int J Diabetes Dev Ctries 40, 227–234 (2020). https://doi.org/10.1007/s13410-019-00789-0

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  • DOI: https://doi.org/10.1007/s13410-019-00789-0

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