Skip to main content
Log in

Three-year prospective evaluation of glucose tolerance, β-cell function and peripheral insulin sensitivity in non-diabetic patients with thalassemia major

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

The aim of this prospective study was to evaluate the evolution of glucose tolerance (GT), insulin secretion and peripheral insulin sensitivity during a 3-yr follow-up in a homogenous population consisting of fourteen non-diabetic adults with thalassemia major (TM). All the patients underwent 2 OGTTs with a 3-yr interval and random mea-surements of fasting glycemia during the entire follow-up. At the time of both OGTTs, peripheral insulin sensitivity was assessed by both homeostatic model assessment (HOMA) index and a novel index derived from the OGTT. At the second OGTT patients exhibited both significantly higher fasting glucose concentrations and enhanced glycemic responses, with greater average glucose areas. GT deterioration over time was accompanied by a reduction of insulin sensitivity, with no concomitant change of insulin secretion. No patient developed diabetes mellitus (DM) during follow-up. To conclude, the natural history of glycometabolic status in TM adults seems to be characterized by a GT deterioration over time, which may probably reflect an increase of insulin resistance. GT deterioration is more evident in patients with the highest responses to the 1st OGTT and particularly in those with pre-existing impaired GT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Italian Working Group on Endocrine Complications in Non-endocrine Diseases. Multicentre study on prevalence of endocrine complications in thalassemia major. Clin. Endocrinol. 1995, 42: 581–586.

    Article  Google Scholar 

  2. Landau H., Glaser B., Admon G., et al. Thalassemia major and diabetes mellitus. J. Endocrinol. Invest. 1990, 13: 100.

    Google Scholar 

  3. Jensen C.E., Tuck S.M., Old J., et al. Incidence of endocrine complications and clinical disease severity related to genotype analysis and iron overload in patients with beta-thalassemia. Eur. J. Haematol. 1997, 59: 76–81.

    Article  PubMed  CAS  Google Scholar 

  4. Galimberti M., De Sanctis V., Lucarelli G., et al. Pancreatic beta-cell function before and after bone marrow transplantation for thalassemia. In: Andò S., Brancati C., (Eds.), Endocrine Disorders in Thalassemia, Springer-Verlag, Berlin-Heidelberg, 1995, p. 161.

    Google Scholar 

  5. Zuppinger K., Molinari B., Hirt A., et al. Increased risk of diabetes mellitus in beta-thalassemia major due to iron overload. Helv. Paediatr. Acta 1979, 34: 197–207.

    PubMed  CAS  Google Scholar 

  6. Lassman M.N., Genel M., Wise J.K., Hendler R., Ferlig P. Carbohydrate homeostasis, pancreatic islet cell function in thalassemia. Ann. Intern. Med. 1974, 80: 65–69.

    Article  PubMed  CAS  Google Scholar 

  7. McIntosh N. Endocrinopathy in thalassemia major. Arch. Diseas. Child. 1976, 51: 195–201.

    Article  CAS  Google Scholar 

  8. Saudek C.D., Hemm R.M., Peterson C.M. Abnormal glucose tolerance in beta-thalassemia major. Metabolism 1977, 26: 43–52.

    Article  PubMed  CAS  Google Scholar 

  9. Ellis J.T., Schulman I., Smith C.H. Generalized siderosis with fibrosis of liver and pancreas in Cooley’s (Mediterranean) anaemia: with observations of the pathogenesis of the siderosis and fibrosis. Am. J. Pathol. 1954, 30: 287–309.

    PubMed Central  PubMed  CAS  Google Scholar 

  10. Fink H. Transfusion haemochromatosis in Cooley’s anaemia. Ann. N.Y. Acad. Sci. 1964, 119: 680–685.

    Article  PubMed  CAS  Google Scholar 

  11. Merkel P.A., Simonson D.C., Amiel S.A., et al. Insulin resistance and hyperinsulinemia in patients with thalassemia major treated by hypertransfusion. N. Engl. J. Med. 1988, 318: 809–814.

    Article  PubMed  CAS  Google Scholar 

  12. Pappas S., Donohue S.M., Denver A.E., et al. Glucose intolerance in thalassemia major is related to insulin resistance and hepatic dysfunction. Metabolism 1996, 45: 652–657.

    Article  PubMed  CAS  Google Scholar 

  13. Dmochowski K., Finegood D.T., Fracombe W., Tyler B., Zinman B. Factors determining glucose tolerance in patients with thalassemia major. J. Clin. Endocrinol. Metab. 1993, 77: 478–483.

    PubMed  CAS  Google Scholar 

  14. Cavallo-Perin P., Pacini G., Cerutti F., et al. Insulin resistance and hyperinsulinemia in homozygous beta-tha-lassemia. Metabolism 1995, 44: 281–286.

    Article  PubMed  CAS  Google Scholar 

  15. Arrigo T., Crisafulli G., Meo A., et al. Glucose tolerance, insulin secretion and peripheral sensitivity in thalas-saemia major. J. Pediatr. Endocrinol. Metab. 1998, 11: 389–393.

    Article  Google Scholar 

  16. Brianda S., Maioli M., Frulio T., et al. The euglycaemic clamp in patients with thalassemia intermedia. Horm. Metab. Res. 1987, 19: 319–322.

    Article  PubMed  CAS  Google Scholar 

  17. De Fronzo F.A., Matsuda M. Insulin sensitivity indices obtained from oral glucose tolerance testing. Diabetes Care 1999, 22: 1462–1470.

    Article  Google Scholar 

  18. Haffner F.M., Gonzales C., Miettinen H., Kennedy E., Stern M.P. A prospective analysis of the HOMA model. Diabetes Care 1996, 19: 1138–1141.

    Article  PubMed  CAS  Google Scholar 

  19. Haffner S.M., Stern M.P., Hazuda H.P., Pugh J.A., Patterson J.K. Hyperinsulinemia in a population at high risk for non-insulin-dependent diabetes mellitus. N. Engl. J. Med. 1986, 15: 220–224.

    Article  Google Scholar 

  20. World Health Organization Study Group. Diabetes Mellitus. Technical Report Series No 727. Geneva: World Health Organization, 1985.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. De Luca.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Messina, M.F., Lombardo, F., Meo, A. et al. Three-year prospective evaluation of glucose tolerance, β-cell function and peripheral insulin sensitivity in non-diabetic patients with thalassemia major. J Endocrinol Invest 25, 497–501 (2002). https://doi.org/10.1007/BF03345490

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345490

Key-words

Navigation