Abstract Ref Number = APCP861
DIABETES MELLITUS SCREENING IN CHILDREN WITH BETA THALASSEMIA MAJOR AND ITS CORRELATION WITH SERUM FERRITIN LEVELS
Siska Mayasari Lubis,Bidasari Lubis
Pediatric Endocrinology Division Child Health Department Faculty of Medicine University of Sumatera Utara Haji Adam Malik General Hospital Medan Indonesia Pediatric HematologyOncology Division, Child Health Department, Faculty of Medicine, University of Sumatera Utara, H Adam Malik General Hospital, Medan, Indonesia
Background : Patients with beta thalassemia major need lifelong blood transfusion in order to maintain an appropriate hemoglobin level, leading to iron overload. Although life expectancy has improved substantially by regular blood transfussion, chronic iron overload results in multiple organ dysfunction and endocrine abnormalities. Diabetes mellitus (DM) is an important complication of beta thalassemia major, but pathophysiologic mechanism leading to DM is unclear.
Material : A cross-sectional study was conducted in a 2 general hospitals in Medan, Sumatera Utara, Indonesia, from March to May 2018. Subjects were children aged below 18 year-old with beta thalassemia major. This study included a questionnaire, anthropometric measurements, and blood test analysis. Serum ferritin level, fasting blood samples (glucose and insulin), urine glucose, hemoglobin A1C (HbA1c) were performed. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for assessing insulin resistance. Data analysis was done using Spearman’s correlation test, Kruskal-Wallis test, p<0.05 was considered as statistically significant.
Results : There were 51 children recruited, females and males comprised 25 (49%) and 26 (51%) respectively. The mean age and ferritin were 2 (1-15) year-old and ferritin 2892.4 (681.6-31285.5) ng/mL, respectively. Age at diagnosis was 36 (3-180) months. Significant correlation was identified between age at diagnosis and volume of transfused blood per occasion with serum ferritin. Fasting blood glucose, fasting insulin, and HOMA-IR were 77 (64-119) mg/dL, 3.1 (0.2-11.3)mIU/L, and 0.6 (0.03-2.41), respectively, and urine glucose was negative in all subjects. Most of our subjects have high level of HbA1c (6.7 (5.2-9,5), but there were no significant correlation between serum ferritin with HbA1c and other parameters (fasting blood glucose and insulin, urinary glucose, and HOMA-IR), with p>0.05.
Conclusions : Our results showed there were no significant correlation between ferritin level with HbA1c, fasting blood glucose and insulin, urine glucose, and HOMA-IR. Significant correlation was identified between age at diagnosis and volume of transfused blood per occasion with serum ferritin. Although we did not find significant correlation between serum ferritin and HbA1c, HbA1C level was found to be high in most of our subjects, therefore we suggested that HbA1c can be one of the routine DM screening in children with beta thalassemia major.
Keywords: Thalassemia Diabetes Mellitus Iron Overload Endocrinopathy