The prevalence of insulin resistance in patients with β -thalassemia major at Cipto Mangunkusumo Hospital

  • Caroline Mulawi
  • Bambang Tridjaja
  • Maria Abdulsalam
  • Zakiudin Munasir
Keywords: thalassemia, impaired glucose tolerance, diabetes mellitus, insulin resistance

Abstract

Background Diabetes mellitus is a common complication in pa-
tients with thalassemia major. Iron overload plays an important role
by damaging the pancreatic β-cell and the liver cell, with the con-
sequences of insulin deficiency and insulin resistance. Family his-
tory of diabetes mellitus is one of the critical factors for the devel-
opment of glucose metabolism derangement. However, the patho-
genesis of glucose metabolism derangement remains unclear.
Objective To evaluate the prevalence of impaired glucose toler-
ance, diabetes mellitus, and insulin resistance in patients with β-
thalassemia major treated in the Thalassemia Outpatient Clinic,
Department of Child Health, Cipto Mangunkusumo Hospital,
Jakarta.
Methods This was a descriptive cross sectional study conducted
in May 2002. Forty-eight subjects aged 10 to 18 years, grouped by
total volume of transfusions and family history of diabetes mellitus,
underwent an oral glucose tolerance test (OGTT), serum transfer-
rin saturation, and insulin level examinations. Insulin resistance
was calculated from fasting plasma glucose and insulin concen-
trations using the homeostasis model assessment (HOMA).
Results One of 48 patients (2%) had impaired glucose tolerance
at the age of 17 years. Diabetes mellitus occurred in three of 48
patients (6%) at the age of 15.5 years in one patient and 18 years
in two patients. Family history of diabetes mellitus was found in 2
patients with diabetes mellitus and in the only one with impaired
glucose tolerance. Insulin resistance was not detected in this study.
Conclusion The prevalence of glucose metabolism derangement
in patients with thalassemia major was low. No insulin resistance
was found in this study

Author Biographies

Caroline Mulawi
Department of Child Health, Medical School, University of
Indonesia, Cipto Mangunkusumo Hospital, Jakarta.
Bambang Tridjaja
Department of Child Health, Medical School, University of
Indonesia, Cipto Mangunkusumo Hospital, Jakarta.
Maria Abdulsalam
Department of Child Health, Medical School, University of
Indonesia, Cipto Mangunkusumo Hospital, Jakarta.
Zakiudin Munasir
Department of Child Health, Medical School, University of
Indonesia, Cipto Mangunkusumo Hospital, Jakarta.

References

1. Sanctis V, Wonke B. Growth and endocrine complica-
tions in thalassaemia major. Roma: Mediprint; 1998.
p.7-42.
2. Weatherall DJ. The thalassemias. In: Beutler E,
LichtmanM, Coller B, Kipps T, editors. Williams he-
matology. 5 th ed. New York: McGraw-Hill; 1995. p.
581-615.
3. Wahidiyat I. Transfusi darah pada thalassemia. In:
Gatot D, Abdulsalam M, Windiastuti E, editors. Darah
dan tumbuh kembang: aspek transfusi. Pendidikan
Kedokteran Berkelanjutan Ilmu Kesehatan Anak XLI;
1998 June 24-25; Jakarta, Indonesia. p. 41-6.
4. Uzel C, Conrad ME. Absorption of heme iron. Semin
Hematol 1998;35:27-34.
5. Karagiorga M, Chatzilliami A, Katsantoni A. Secondary
diabetes mellitus in thalassemic patients. In: Ando S,
Brancati C, editors. Endocrine disorders in thalassemia.
Physiopathological and theurapetical aspects. 2 nd ed. Ber-
lin: Springer Verlag; 1995. p. 161-5.
6. Anastasi S, Caruso V, Cantone M, Magnano C. Insu-
lin-dependent diabetes mellitus in a group of young
people with beta-thalassemia major. In: Ando S,
Brancati C, editors. Endocrine disorders in thalassemia.
Physiopathological and therapeutical aspects. 2 nd ed.
Berlin: Springer Verlag; 1995. p. 149-51.
7. Wonke B, Hanslip JI. Glucose intolerance and diabe-
tes in thalassemia major. In: Ando S, Brancati C, edi-
tors. Endocrine disorders in thalassemia. Physiopatho-
logical and therapeutical aspects. 2 nd ed. Berlin:
Springer Verlag; 1995. p. 65-7.
8. Setiawan S. Thalassemia beta mayor: prevalensi im-
paired fasting glucose dan diabetes melitus serta
gambaran hematologi pada penderita yang mendapat
transfusi berulang [thesis]. Jakarta: Bagian Patologi
Klinik FKUI; 2000.
9. American Diabetes Association: Clinical practice rec-
ommendations 1999. Report of the Expert Committee
on the diagnosis and classification of diabetes melli-
tus. Diabetes Care 1999;22:S5-16.
10. Haeften TW. Glucose tolerance, insulin sensitivity, and
the homeostasis model assessment method. Diabetes
Care 1998;21:2191.
11. Chern JP, Lin KH, Lu MY. Abnormal glucose toler-
ance in transfusion-dependent b thalassemic patients.
Diabetes Care 2001;24:850-4.
12. Matsuda M, De Fronzo R. Insulin sensitivity indices
obtained from oral glucose tolerance testing. Compari-
son with euglycemic insulin clamp. Diabetes Care
1999;22:1462-70.
Published
2016-09-24
How to Cite
1.
Mulawi C, Tridjaja B, Abdulsalam M, Munasir Z. The prevalence of insulin resistance in patients with β -thalassemia major at Cipto Mangunkusumo Hospital. PI [Internet]. 24Sep.2016 [cited 12Aug.2022];43(4):117-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/673
Section
Articles
Received 2016-09-23
Accepted 2016-09-23
Published 2016-09-24