Frequency of Various Glycemic Abnormalities in Children and Adolescents with Beta Thalassemia Major

Authors

  • Sana Feroz Department of Pediatric Medicine, Nishtar Hospital, Multan, Punjab, Pakistan.
  • Sulaiman Department of Pediatric Medicine, Nishtar Hospital, Multan, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i7.2426

Keywords:

Beta-thalassemia Major, Prediabetes, Diabetes Mellitus, Ferritin, Glycemic Abnormalities

Abstract

Background: Beta-thalassemia major is a significant hereditary disorder leading to transfusion-dependent anemia and iron overload. Chronic transfusions result in systemic iron deposition, predisposing to multiple endocrine complications, particularly disturbances in glucose metabolism. The reported frequency of glycemic abnormalities varies across populations, emphasizing the need for local epidemiological data to guide early screening and intervention strategies. Objective: To determine the frequency of prediabetes and diabetes among children and adolescents with beta-thalassemia major and to analyze associated biochemical parameters. Methods: A descriptive cross-sectional study was conducted in the Department of Pediatrics, Nishtar Hospital, Multan, from December 2023 to May 2024. A total of 146 patients aged 12–18 years with confirmed beta-thalassemia major were enrolled through consecutive sampling. Patients with pre-existing diabetes, concurrent conditions, or medications affecting glucose metabolism were excluded. Fasting plasma glucose was used to assess glycemic status, while serum hemoglobin and ferritin levels were measured to evaluate disease and iron overload status. Data were analyzed using SPSS v26, and frequencies of glycemic abnormalities were calculated. Results: The mean age was 14.55 ± 1.71 years, with 55.5% males. The mean disease duration was 6.91 ± 1.51 years, and mean transfusion duration was 8.82 ± 1.72 years. Mean serum hemoglobin was 9.18 ± 1.57 g/dL, and mean ferritin level was 31.80 ± 12.95 ng/mL. Prediabetes was detected in 53.4% and diabetes in 28.1% of patients, indicating a high prevalence of glycemic abnormalities despite ongoing chelation therapy. Conclusion: Children and adolescents with beta-thalassemia major exhibit a high frequency of prediabetes and diabetes, necessitating routine metabolic screening and optimization of iron chelation to prevent long-term complications.

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References

1. Jaing, T., Chang, T., Chen, S., Lin, C., Wen, Y., & Chiu, C. (2021). Molecular genetics of β-thalassemia. Medicine, 100(45), e27522.

https://doi.org/10.1097/md.0000000000027522

2. Kattamis, A., Forni, G. L., Aydinok, Y., & Viprakasit, V. (2020). Changing patterns in the epidemiology of β‐thalassemia. European Journal of Haematology, 105(6), 692-703.

https://doi.org/10.1111/ejh.13512

3. Anwer, J., Baber, M. I., & Niazi, K. U. (2016). Frequency of Abnormal GTT in Children with Beta Thalassemia Major. PAKISTAN JOURNAL OF MEDICAL & HEALTH SCIENCES, 10(3), 990-993.

4. Diab, A. M., Abdelmotaleb, G. S., Abdel-Azim Eid, K., Mostafa, E. S., & Ahmed, E. S. (2021). Evaluation of glycemic abnormalities in children and adolescents with β-thalassemia major. Egyptian Pediatric Association Gazette, 69(1).

https://doi.org/10.1186/s43054-021-00052-4

5. Ibrahim, A. S., Abd El-Fatah, A. H., Abd El-Halim, A. F., & Mohamed, F. F. (2023). Serum ferritin levels and other associated parameters with diabetes mellitus in adult patients suffering from beta thalassemia major. Journal of Blood Medicine, 14, 67-81.

https://doi.org/10.2147/jbm.s390666

6. Solanki, D. K., Dewangan, S., & Sahu, B. (2020). Study of glycemic status, thyroid function and vitamin D3 level in children with β thalassemia majorin a tertiary care center. Pediatric Review: International Journal of Pediatric Research, 7(5), 204-209.

https://doi.org/10.17511/ijpr.2020.i05.03

7. Vang, P., Zongrum, O., Sindhuphak, R., & Dusitsin, N. (2007). Preliminary Study on Thalassemia Screening and Genetic Counseling in Selective Hmong People in Saraburi Province, Thailand. Hmong Studies Journal, 8.

https://www.hmongstudiesjournal.org/uploads/4/5/8/7/4587788/vangzongrumsindhuphakdusitsinhsj8.pdf

8. Cao, A., Furbetta, M., Galanello, R., Melis, M. A., Angius, A., Ximenes, A., ... & Scalas, M. T. (1981). Prevention of homozygous beta-thalassemia by carrier screening and prenatal diagnosis in Sardinia. American journal of human genetics, 33(4), 592.

9. Abdullah, K. N., Azim, W., & Liaqat, J. (2010). Beta-thalassemia-institution based analysis of ethnic and geographic distribution, effect of consanguinity and safety of chorionic villus sampling as a diagnostic, tool for pre-natal diagnosis in selected patients. Pakistan Armed Forces Medical Journal, (4).

10. Mahmood Baig, S., Sabih, D., Rahim, M. K., Azhar, A., Tariq, M., Sajid Hussain, M., Saqlan Naqvi, S. M., Raja, G. K., Khan, T. N., Jameel, M., Iram, Z., Noor, S., Baig, U. R., Qureshi, J. A., Baig, S. A., & Bakhtiar, S. M. (2012). β-thalassemia in Pakistan. Journal of Pediatric Hematology/Oncology, 34(2), 90-92.

https://doi.org/10.1097/mph.0b013e31823752f3

11. Torres, A. F., Bonduel, M., Sciuccati, G., del Pozo, A., Roldán, A., Ciaccio, M., ... & Muriel, F. S. (2002). β TALASEMIA MAYOR EN LA ARGENTINA. MEDICINA (Buenos Aires), 62(2), 124-134.

12. El-Hazmi, M. A., Al-Swailem, A., Al-Fawaz, I., Warsey, A. S., & Al-Swailem, A. (1994). Diabetes mellitus in children suffering from -thalassaemia. Journal of Tropical Pediatrics, 40(5), 261-266.

https://doi.org/10.1093/tropej/40.5.261

13. Cario, H., Holl, R. W., Debatin, K., & Kohne, E. (2003). Insulin sensitivity and β-cell secretion in thalassaemia major with secondary haemochromatosis: Assessment by oral glucose tolerance test. European Journal of Pediatrics, 162(3), 139-146.

https://doi.org/10.1007/s00431-002-1121-7

14. Gamberini, M. R., Fortini, M., De Sanctis, V., Gilli, G., & Testa, M. R. (2005). Diabetes mellitus and impaired glucose tolerance in thalassaemia major: incidence, prevalence, risk factors and survival in patients followed in the Ferrara Center. Pediatric Endocrinology Reviews, 2, 285.

15. Hafez, M., Youssry, I., El-Hamed, F. A., & Ibrahim, A. (2009). Abnormal glucose tolerance in β-thalassemia: Assessment of risk factors. Hemoglobin, 33(2), 101-108.

https://doi.org/10.1080/03630260902817131

16. Khalifa, A. S., Salem, M., Mounir, E., El-Tawil, M. M., El-Sawy, M., & Abd Al-Aziz, M. M. (2004). Abnormal glucose tolerance in Egyptian beta-thalassemic patients: Possible association with genotyping. Pediatric Diabetes, 5(3), 126-132.

https://doi.org/10.1111/j.1399-543x.2004.00051.x

17. Merkel, P. A., Simonson, D. C., Amiel, S. A., Plewe, G., Sherwin, R. S., Pearson, H. A., & Tamborlane, W. V. (1988). Insulin resistance and Hyperinsulinemia in patients with thalassemia major treated by Hypertransfusion. New England Journal of Medicine, 318(13), 809-814.

https://doi.org/10.1056/nejm198803313181303

18. Dmochowski, K., Finegood, D. T., Francombe, W., Tyler, B., & Zinman, B. (1993). Factors determining glucose tolerance in patients with thalassemia major. The Journal of Clinical Endocrinology & Metabolism, 77(2), 478-483.

https://doi.org/10.1210/jcem.77.2.8345055

19. Multicentre Study On Prevalence of Endocrine Complications in Thalassaemia Major. (1995). Italian working group on endocrine complications in non-endocrine diseases. Clin Endocrinol (Oxf), 42(6), 581-586.

20. Gamberini, M. R., Fortini, M., Gilli, G., Testa, M. R., & De Sanctis, V. (1998). Epidemiology and chelation therapy effects on glucose homeostasis in thalassaemic patients. Journal of pediatric endocrinology & metabolism: JPEM, 11, 867-869.

https://europepmc.org/article/med/10091159

21. Hafez, M., Youssry, I., El-Hamed, F. A., & Ibrahim, A. (2009). Abnormal glucose tolerance in β-thalassemia: Assessment of risk factors. Hemoglobin, 33(2), 101-108.

https://doi.org/10.1080/03630260902817131

22. El-Hazmi, M. A., Warsy, A. S., & Al-Fawaz, I. (1994). Iron-endocrine pattern in patients with -thalassaemia. Journal of Tropical Pediatrics, 40(4), 219-224.

https://doi.org/10.1093/tropej/40.4.219

23. Khalifa, A. S., Salem, M., Mounir, E., El-Tawil, M. M., El-Sawy, M., & Abd Al-Aziz, M. M. (2004). Abnormal glucose tolerance in Egyptian beta-thalassemic patients: Possible association with genotyping. Pediatric Diabetes, 5(3), 126-132.

https://doi.org/10.1111/j.1399-543x.2004.00051.x

24. De Sanctis, V., Zurlo, M. G., Senesi, E., Boffa, C., Cavallo, L., & Di Gregorio, F. (1988). Insulin dependent diabetes in thalassaemia. Archives of disease in childhood, 63(1), 58-62.

https://adc.bmj.com/content/63/1/58.abstract

25. Platis, O., Anagnostopoulos, G., Farmaki, K., Posantzis, M., Gotsis, E., & Tolis, G. (2004). Glucose metabolism disorders improvement in patients with thalassaemia major after 24-36 months of intensive chelation therapy. Pediatric Endocrinology Reviews: PER, 2, 279-281.

26. Christoforidis, A., Perifanis, V., Tsatra, I., Vlachaki, E., & Athanassiou-Metaxa, M. (2008). Glucose metabolism in conventionally treated patients with b-thalassaemia major assessed with oral glucose tolerance test. Archives of Medical Science, 4(2), 191-196.

27. Arrigo T, Crisafulli G, Meo A, Lombardo F, Miceli M, De Luca F. (1998). Glucose tolerance, insulin secretion and sensitivity in thalassemia major. J Pediatr Endocrinol Metab, 11(Suppl 3), 863–6.

28. Sougleri, M., Labropoulou-Karatza, C., Paraskevopoulou, P., Fragopanagou, H., & Alexandrides, T. (2001). Chronic hepatitis C virus infection without cirrhosis induces insulin resistance in patients with β-thalassaemia major. European Journal of Gastroenterology & Hepatology, 13(10), 1195-1199.

https://doi.org/10.1097/00042737-200110000-00012

29. Bhat, K., & Periasamy, P. (2014). Effect of long-term transfusion therapy on the glycometabolic status and pancreatic beta cell function in patients with beta thalassemia major. Journal of Family Medicine and Primary Care, 3(2), 119.

https://doi.org/10.4103/2249-4863.137621

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Published

2025-07-15

How to Cite

Feroz, S., & Sulaiman. (2025). Frequency of Various Glycemic Abnormalities in Children and Adolescents with Beta Thalassemia Major. Indus Journal of Bioscience Research, 3(7), 1136-1141. https://doi.org/10.70749/ijbr.v3i7.2426