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Diabetes mellitus in children suffering from beta-thalassaemia
M A el-Hazmi1, A al-Swailem, I al-Fawaz
1Department of Medical Biochemistry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Diabetes mellitus is a complication of beta-thalassaemia major, linked to iron overload. Saudi children with beta-thalassaemia major showed a 6% diabetes prevalence, lower than other ethnic groups.
Area of Science:
- Hematology
- Endocrinology
- Metabolic Disorders
Background:
- Insulin-dependent diabetes mellitus (IDDM) is a common complication in beta-thalassaemia major patients.
- Iron overload damaging pancreatic beta-cells is the suspected cause, with liver disorders and genetics as contributing factors.
- Ethnic variations influence diabetes prevalence and complications in beta-thalassaemia.
Purpose of the Study:
- To investigate the prevalence of diabetes mellitus and impaired glucose tolerance (IGT) in Saudi children with beta-thalassaemia major and minor.
- To explore the relationship between diabetes and predisposing factors like iron overload and liver function.
- To compare diabetes prevalence in Saudi thalassaemia patients with international data.
Main Methods:
- Studied 50 Saudi children with beta-thalassaemia major, 50 with beta-thalassaemia minor, and age/sex-matched controls.
- Assessed fasting blood glucose, plasma insulin, liver function tests, plasma ferritin, iron, and transferrin.
- Evaluated glucose tolerance and compared results across groups.
Main Results:
- Elevated ferritin levels were common in beta-thalassaemia major patients despite therapy.
- Abnormal insulin levels (hyper- or hypoinsulinaemia) were frequent in beta-thalassaemia major.
- Diabetes prevalence was 6% in beta-thalassaemia major vs. 2% in minor/controls; IGT was 24% in major vs. 2% in minor/0% in controls.
Conclusions:
- Saudi children with beta-thalassaemia major have a significant prevalence of diabetes and IGT, associated with iron overload.
- Diabetes prevalence in this Saudi cohort is lower than reported in other ethnic groups.
- Iron overload and altered insulin levels are key factors in diabetes development in beta-thalassaemia.
Abstract:
Insulin-dependent diabetes mellitus (IDDM) is a frequent complication in patients with beta-thalassaemia major. It is believed to be a consequence of the damage inflicted by iron overload to the pancreatic beta-cell. Liver disorders and genetic influences seem to be additional predisposing factors to diabetes mellitus in patients with beta-thalassaemia. Ethnic variations are frequently reported on prevalence and complications of diabetes mellitus in the beta-thalassaemia patients. We investigated 50 Saudi children (< 15 years) with beta-thalassaemia major and 50 beta-thalassaemia minor, and age- and sex-matched controls for the prevalence of diabetes mellitus, and its relation to hitherto claimed predisposing factors. Fasting blood glucose, plasma insulin level, liver function tests, plasma ferritin, iron, and transferrin were assessed in each patient and glucose tolerance was evaluated. Results in patients with beta-thalassaemia major were compared with those obtained for beta-thalassaemia minor and the controls. The results showed moderate elevation of ferritin level in the majority of the beta-thalassaemia major despite desferroxamine therapy. Either hyperinsulinaemia or hypoinsulinaemia was encountered in the majority of these patients. The prevalence of diabetes mellitus was 6 per cent compared to 2 per cent in the beta-thalassaemia minor and normal children. Impaired glucose tolerance (IGT) occurred at a significantly higher (24 per cent) frequency in the beta-thalassaemia major compared to 2 and 0 per cent in the beta-thalassaemia minor patients and normal controls, respectively. The prevalence of diabetes mellitus was significantly lower in the Saudi thalassaemic patients compared to the results obtained from patients of other ethnic groups reported in literature.(ABSTRACT TRUNCATED AT 250 WORDS)