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

Background Diabetes mellitus is a common complication in patients with thalassemia major. Iron overload plays an important role by damaging the pancreatic β-cell and the liver cell, with the consequences of insulin deficiency and insulin resistance. Family history of diabetes mellitus is one of the critical factors for the development of glucose metabolism derangement. However, the pathogenesis of glucose metabolism derangement remains unclear. Objective To evaluate the prevalence of impaired glucose tolerance, 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 transferrin saturation, and insulin level examinations. Insulin resistance was calculated from fasting plasma glucose and insulin concentrations 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.