bstract
Background: The quality of life of B-thalassemia major (β-TM) patients has improved with the use of frequent
blood transfusions. However, this leads to chronic iron overload with its sequelae, as prediabetes and diabetes
mellitus. This study aimed to assess insulin resistance and glucose abnormalities in a sample of B-thalassemia major
patients in Benha, Egypt.
Results: This case-control study included 40 B-thalassemia major patients on regular blood transfusion and iron
chelation. Their ages ranged from 8 to 16 years, and 30 normal age and sex-matched controls. Thorough clinical
examination was performed including weight (kg), height (m), body mass index (BMI) (kg/m2
), and liver and spleen
size. Laboratory investigations were done in the form of complete blood count, liver enzymes, serum ferritin, fasting
plasma insulin, and fasting, and 2 h postprandial plasma glucose. Insulin resistance (IR) was calculated using the
Homeostasis Model Assessment of insulin resistance (HOMA-IR) index. Insulin resistance was found in 27.5% of
thalassemic patients; 18.2% of them had diabetes, 72.7% were prediabetics (with impaired fasting glycemia), and
9.1% had normal fasting and 2 h postprandial plasma glucose level. Insulin resistance increased significantly with
increased blood transfusion duration, serum ferritin, liver enzymes, fasting plasma insulin, fasting plasma glucose,
and 2 h postprandial plasma glucose (ROC). The curve analysis showed that the duration of blood transfusion,
serum ferritin, fasting plasma insulin, fasting, and 2 h postprandial plasma glucose could significantly predict insulin
resistance at a certain cut-off point.
Conclusion: Our data show that HOMA-IR can be used to detect insulin resistance in β-TM patients on long-term
blood transfusions, especially patients with high serum ferritin and impaired liver enzymes.