Association Between Iron Overload and Glucose Metabolism in Children and Youth with Transfusion-Dependent Beta Thalassemia: The Role of Chelation Therapy.

BACKGROUND

Transfusion-dependent thalassemia (TDT) is a transfusion-dependent anemia frequently associated with iron overload, which may disrupt liver function and glucose metabolism.

OBJECTIVE

This study aimed to evaluate glucose dysregulation and the effects of iron chelation therapy in pediatric TDT patients.

METHODOLOGY: This retrospective study included 31 children and adolescents (aged 7-23 years) with TDT who were followed at a tertiary-care pediatric hematology center with available oral glucose tolerance test (OGTT) data. Clinical and laboratory data were analyzed, including oral glucose tolerance test (OGTT), serum ferritin, alanine aminotransferase (ALT), glycated hemoglobin (Hb A1c), C-peptide, homeostatic model assessment for insulin resistance (HOMA-IR), abdominal ultrasonography (USG), and liver and cardiac magnetic resonance imaging (MRI). Diagnosis of diabetes mellitus (DM) and prediabetes was based on American Diabetes Association (ADA) criteria.

RESULTS

OGTT was performed in 28 patients; impaired fasting glucose (IFG) was observed in 10.7%, impaired glucose tolerance (IGT) in 3.6%, and 85.7% had normal glucose regulation. All received consistent oral chelation with film-coated deferasirox. ALT showed significant correlation with age at chelation onset (r=0.49, p=0.00), C-peptide (r=0.45, p=0.02), and age at diagnosis (r=0.56, p=0.001). Duration of chelation correlated with hepatomegaly severity (r=0.61, p=0.00), 30-minute glucose (r=0.39, p=0.03), and insulin levels at 30 (r=0.37, p=0.04) and 90 minutes (r=0.39, p=0.03). No significant association was found between ferritin and OGTT values (p>0.05).

CONCLUSIONS

Overt glucose metabolism disorders were uncommon and should be interpreted cautiously. These results highlight the critical role of adherence to chelation and metabolic monitoring to prevent DM in children with TDT.