Serum Ferritin Levels and Other Associated Parameters with Diabetes Mellitus in Adult Patients Suffering from Beta Thalassemia Major

Abstract

Background Although beta thalassemia major (BTM) patients are properly treated with blood transfusions in accompany with iron chelation therapy, they suffer from complications, such as diabetes mellitus (DM). Purpose The purpose was to detect the critical serum ferritin level and other parameters correlated with DM among adult BTM patients. Also, it was to study whether each of these parameters is associated with a certain period of age. Patients and Methods This study included 200 adult BTM patients. A cross-sectional study was carried out. Patients clinical and laboratory variables, such as ferritin levels, and fasting blood glucose (FBS) were extracted from medical records at Zagazig University Hospital, Egypt. Liver and cardiac iron contents were assessed using MRI T2* methods. Statistical analysis was performed using IBM SPSS V26.0 software package. Results The overall frequency of DM over the total sample equals 6.5%. There were no impaired fasting glucose (IFG) in the medical records. Statistical significance between serum ferritin and DM was (P = 0.014). The serum ferritin 2500 ng/mL with age group (27–<32) years-old were risk factors. The distributions of DM according to BMI were (3.5%) of class overweight. Significant association between DM and BMI was (r = 0.357, P < 0.001). Liver MRI T2* has significant correlation with serum ferritin, but cardiac MRI T2* was poorly correlated. Association between liver and cardiac MRI T2* was not found. Conclusion Age group (27–<32) years-old and ferritin >2500 ng/mL should be properly treated immediately. The serum ferritin and BMI of class “overweight” were risk factors for DM. Factors such as diet should be followed. Serum ferritin can be used for estimating liver iron content for economic factors. But cardiac MRI T2* must be performed for evaluating cardiac iron accurately.

Endocrinopathies in Hemoglobinopathies: What Is the Role of Iron?

“…In Table 1, the prevalence of DM in β-thalassemia is reported and varies from 0% to 35% [10][11][12][13][14][15]. Risk factors for impaired glucose metabolism include older age, high body mass index (BMI), elevated mean ferritin serum levels, and history of splenectomy [11,12,[16][17][18]. Impaired insulin secretion due to iron deposition in the pancreas, insulin resistance, iron-induced fatty acid oxidation with a subsequent decrease in glucagon usage rate, and zinc deficiency contribute to the pathogenesis of DM in β-thalassemia [4,[19][20][21][22].…”

β-Thalassemia and Diabetes Mellitus: Current State and Future Directions

“…Although diabetes is a multi-factorial disease, iron overload is a primary contributing factor. Several studies have shown excessive iron deposition in pancreatic β-cells in β-thalassemia major patients undergoing frequent blood transfusion and iron chelation therapy [24]. Therefore, better management of iron overload in β-thalassemic/pre-diabetics may reduce the risk or delay the onset of diabetes in this patient group.…”

Manifestações clínicas da beta talassemia maior na população pediátrica: Uma revisão sistemática

“…Assim, as alfas globinas se agregam de maneira que danificam as hemácias, causando hemólise. Como consequência os indivíduos apresentam quadros de anemia e consequentemente fadiga, falta de ar, fraqueza, dores de cabeça e até hepatoesplenomegalia, ou retardo de crescimento, problemas cardíacos, alterações pancreáticas e diabetes (Forni et al, 2023;Ibrahim et al, 2023). Indivíduos portadores de beta talassemia apresentam formas clinicamente significativas e que variam de acordo com as mutações primárias deste indivíduo.…”