Contributions
Abstract: PB1807
Type: Publication Only
Session title: Thalassemias
Background
Current guidelines recommend yearly evaluation of glucose metabolism with Oral Glucose Tolerance Test (OGTT) in patients with transfusion-dependent thalassemia from their 10th year of age onwards.
Aims
To retrospectively analyse all the OGTT tests performed in a single pediatric center during the last decade and evaluate the necessity of yearly performed OGTT in patients with transfusion-dependent b-thalassemia during the second decade of life.
Methods
One hundred and seventy tests performed in 39 patients (24 boys) were included in the analysis. Mean age at the time of each OGTT was 14.15 ± 2.79 years.
Results
Seventeen tests (10%) in 8 patients (5 boys) were characterized as Impaired Glucose Tolerance (IGT) with a 2-hour glucose value above 140 mg/dl but below 200 mg/dl. In 20 tests (87.06%) fasting glucose values were between 100-125 mg/dl (Impaired Fasting Glucose, IFG), whereas in 2 tests (1.18%) fasting glucose values were above 200 mg/dl (Diabetes Mellitus, DM). These 22 abnormal fasting glucose values were belonged to 12 patients (8 boys). Acknowledging the fact that there could be sporadic technical errors, especially in fasting glucose abnormal values, we selectively separated patients with either IGT and abnormal HOMA, MATSUDA or QUICKI indices or persistent IFG or IGT. With these criteria, 7 patients (4 boys) were identified. When compared with the rest 32 patients, these 7 patients with a definite abnormal glucose metabolism did not significantly differ regarding their age, anthropometric parameters or ferritin levels. In order to address selection criteria for performing OGTT but without missing a single patient with a definite glucose intolerance, these criteria should include: i) a first OGTT test at the initiation of puberty, ii) OGTT in any patient with a fasting glucose above 100 mg/dl and iii) OGTT in any patient with a ΗΟΜΑ-IR index above 1.85 and yearly onwards. By adopting these criteria in our cohort of patients, not a single patient with consistent abnormal glucose metabolism would have been missed, while, on the other hand, total OGTT tests performed could have been reduced from 170 to only 91, translating to a significant reduction of 46.47%.
Conclusion
Only a small percentage of young patients with transfusion-dependent b-thalassemia exhibit abnormal glucose metabolism during their second decade of life. By adopting specific selection criteria, one may avoid the performing of this time- and money-consuming test in a significant proportion of patients, albeit, without sacrificing timely detection and intervention.
Keyword(s): Beta thalassemia
Abstract: PB1807
Type: Publication Only
Session title: Thalassemias
Background
Current guidelines recommend yearly evaluation of glucose metabolism with Oral Glucose Tolerance Test (OGTT) in patients with transfusion-dependent thalassemia from their 10th year of age onwards.
Aims
To retrospectively analyse all the OGTT tests performed in a single pediatric center during the last decade and evaluate the necessity of yearly performed OGTT in patients with transfusion-dependent b-thalassemia during the second decade of life.
Methods
One hundred and seventy tests performed in 39 patients (24 boys) were included in the analysis. Mean age at the time of each OGTT was 14.15 ± 2.79 years.
Results
Seventeen tests (10%) in 8 patients (5 boys) were characterized as Impaired Glucose Tolerance (IGT) with a 2-hour glucose value above 140 mg/dl but below 200 mg/dl. In 20 tests (87.06%) fasting glucose values were between 100-125 mg/dl (Impaired Fasting Glucose, IFG), whereas in 2 tests (1.18%) fasting glucose values were above 200 mg/dl (Diabetes Mellitus, DM). These 22 abnormal fasting glucose values were belonged to 12 patients (8 boys). Acknowledging the fact that there could be sporadic technical errors, especially in fasting glucose abnormal values, we selectively separated patients with either IGT and abnormal HOMA, MATSUDA or QUICKI indices or persistent IFG or IGT. With these criteria, 7 patients (4 boys) were identified. When compared with the rest 32 patients, these 7 patients with a definite abnormal glucose metabolism did not significantly differ regarding their age, anthropometric parameters or ferritin levels. In order to address selection criteria for performing OGTT but without missing a single patient with a definite glucose intolerance, these criteria should include: i) a first OGTT test at the initiation of puberty, ii) OGTT in any patient with a fasting glucose above 100 mg/dl and iii) OGTT in any patient with a ΗΟΜΑ-IR index above 1.85 and yearly onwards. By adopting these criteria in our cohort of patients, not a single patient with consistent abnormal glucose metabolism would have been missed, while, on the other hand, total OGTT tests performed could have been reduced from 170 to only 91, translating to a significant reduction of 46.47%.
Conclusion
Only a small percentage of young patients with transfusion-dependent b-thalassemia exhibit abnormal glucose metabolism during their second decade of life. By adopting specific selection criteria, one may avoid the performing of this time- and money-consuming test in a significant proportion of patients, albeit, without sacrificing timely detection and intervention.
Keyword(s): Beta thalassemia