Investigation Of Glucose Metabolism In Patients With Intermediate Thalassemiaand The Value Of Fructosamine In Its Blood Glucose Monitoring

Objective To understand the glucose metabolism in thalassemia intermediate patients and to explore the value of fructosamine in blood glucose monitoring in thalassemia intermediate patients.Methods All the 221 thalassemia intermediate patients were enrolled in Department of Hematology,the First Affiliated Hospital of Guangxi Medical University from 2013 to 2016.Blood glucose,insulin,serum ferritin,liver function and thyroid function were measured in the morning,followed by oral glucose tolerance test and insulin release test.Blood glucose and insulin were collected at 30min and 120min respectively.According to blood sugar levels,All the patients were divided into hypoglycemia group,normal blood glucose group and hyperglycemia group.SPSS 21.0 statistical software was used to analyze the data.Results（1）Of the 221 thalassemia intermediate patients,there were 35cases（15.8%）of fasting hypoglycemia,0 case of impaired fasting glucose,26cases（11.8%）and 6 cases（2.7%）of diabetes mellitus.The earliest onset of impaired glucose tolerance is 16 years old,the earliest onset of diabetes is 20years old.（2）The levels of INS120（264.90[172.14,452.00]）in the hyperglycemia group were higher than those in the low blood glucose group and normal blood glucose group（106.00[82.99,262.80],121.14[51.75,217.88],respectively,P<0.001）.The levels of△I₃₀/△G₃₀（33.15[13.91,61.12]）in the hyperglycemia group were lower than those in the low blood glucose group（52.99[33.07,79.74],58.79[27.41,105.58],respectively,P<0.001）.The levels of HOMA-IR（5.34[3.16,12.38]）in the hyperglycemia group were higher than that in the normal blood glucose group（4.90[3.19,7.52],P<0.001）.The ISI in the hyperglycemia group（0.13[0.07,0.19]）and the normal blood glucose group（0.14[0.09,0.20]）was lower than that in the hypoglycemia group（0.10[0.08,0.14]）,and there was a significant difference between the normal blood glucose group and the low blood glucose group（P=0.041）.The incidence of iron overload was 40.1%（79/197）.The incidence of mild to moderate iron overload and severe iron overload was 26.4%（52/197 cases）,13.7%（27/197 cases）,respectively.The incidence of hyperglycemia in severe iron overload group（44.4%（12/27））was significantly higher than that in normal group and mild to moderate iron overload group（10.2%（12/118 cases）,13.5%（7/52 cases）,respectively）（P<0.05）.（4）There was no significant difference in fructosamine between hypoglycemia group,normal blood glucose group and hyperglycemia group（P>0.05）.There was a negative correlation between serum ferritin and fructosamine（r=-0.178,P=0.015）.Conclusions（1）Of the 221 thalassemia intermediate patients,there were 35cases（15.8%）of fasting hypoglycemia,0 case of impaired fasting glucose,26cases（11.8%）and 6 cases（2.7%）of diabetes mellitus.（2）thalassemia intermediate patients exist with insulin resistance,may be accompanied by inadequate insulin secretion and decreased insulin sensitivity.（3）thalassemia intermediate patients exist with iron overload phenomenon universally,and the more serious iron overload is,the higher risk of impaired glucose tolerance or diabetes would be.（4）Fructosamine may not be a good indicator of blood glucose levels in thalassemia intermediate patients.