Background: Iron interferes with insulin action. Iron interfers inhibition of glucose production by insulin in liver. Hepatic extraction and metabolism of insulin is reduced with increasing iron stores, leading to peripheral hyperinsulinemia (51) and the initial and most common abnormality seen in iron overload condition is insulin resistance.(23)

Method: About 1 ml of fasting blood of patient was collected in a plain glass vial and then plasma separated.1.75gm/kg body weight glucose dissolved in water was given to the patient & time was noted.4 samples were collected at a time interval of half an hour for two hours, after giving glucose.

Determination of blood glucose was done by glucose oxidase peroxidase method

Conclusion: Significant variation was found (p value<0.001) in children with impaired glucose tolerance compared to normal glucose tolerance with respect to age, weight, age of diagnosis.

Keywords: Abnormal GTT, β thalassemia

1. Debaun MR, Vinchisky E. Hemoglobinopathies. In: Kliegman, Behrman, Jenson, Stanton, editors. Nelson textbook of Pediatrics. 18th ed. Philadelphia: Elsevier; 
2. Agrawal MB. Living with Thalassemia; Bombay Bhilani Book Depot 1996.
3. (A) (B) Praful B Godkar and Darshan P Godkar. Text Book of Medical Laboratory Technology.2003 second edition
4. Arrigo T, Crisafulli G, Meo A, Sturiale M, Combardo F. Micelli, Cucinotta D, De Luea F.Glucose tolerance, insulin secretion and peripheral sensitivity in thalassemia major.J Pediatr Endocrinol Metab. 1998; supply 3:863-6
5. Al Eiq AH, Ai Saeed HH.Endocrinopathies in patients with thalassemia.Saudi Med J. 2004 Oct;25(10):1347-51
6. Barbieri M, Ragno E, Benvenutti E, Zito GA, Corsi A, Ferrucci L. New aspects of insulin resistance syndrome impact on hematologic parameters. Diabeteologia 2001;44:1232-1237
7. Britton RS, Leicerter KL, Bacon BR.Iron toxicity and chelation therapy. Int J Hematol.2002 Oct;76(3):219-28
8. Bothwell TH, Finch CA.Iron metabolism. Boston; Little, Brown:1962.
9. Brittenham GM,Farrell DE,Harris JW et al.Magnetic susceptibility measurement of human iron stores.N Engl J Med 1982;307:1671-1675.
10. Brittenham GM, Giriffith PM, Nienhuis AW et al. Efficiancy of deferoxamine in preventing complications of iron overload in patients with thalassemia major.N Engl J Med.1994;331:567-73.
11. Bertelsen M,Auggard EF,Carrier MJ. Oxidative stress impairs insulin internalization in endothelial cells invitro.Diabetologia.2001;44:605-613.
12. Cook JD, Barry WE,Hershko C,Fillet G, Finch CA.Iron kinetics with emphasis on iron overload.Am J Pathol 1993;72:337-343.
13. Caterina Borgna Pignatti, Simone Rugolotta, Piero De Stefano, Antoniopiga, Felicia Di Gregorio, Maria Rita Gamberini,Vincenzo Sabato,Caterina Malevendi,Mario Do.Survival and disease complications in thalassemia major.Annuals of the New York Academy of Science 1998;850:227-231.
14. Catalano C,Muscelli E,Quifiones A,Baldi S,Ciociaaro D,Segnieri G,Ferramnini E.Reciprocal association between insulin sensitivity and the hematocrit in man.Diabetes 1996;45(suppl.2):323A.
15. Carvallo-Perin P, Pacini G, Cerutti F, Bessone A, Condo C, Sacchetti L.Insulin resistance and hyperinsulinemia in homozygous beta thalassemia.Metabolism 1995;44:281-286
16. Cario H, Holl RW, Debatin KM, Kohne E.Dispropotionately elevated fasting proinsulin levels in normoglycemic patients with thalassemia major are correlated to the degree of iron overload. Horm Res,2003; 59:73-8
17. Cario H, Holl RW, Debatin KM, Kohne E. Insulin sensitivity and beta cell secretion in thalassemia major with secondary hemochromatosis: assessement by oral glucose tolerance test.Eur J Pediatr,2003 Mar;162:13946
18. Chan YL, Li CK, Chik KW, Law MY. Howard R.Liver volume in thalassemia major:relationship with body weight, serum ferritin and liver function. Pediatr Radiol.2005 Feb;35(2):165-8
19. Cooley TB, Loe P. Aseries of cases of spleenomegaly in children with anemia and peculiar bone changes.Trans Am Pediatr Soc,1925;37:29-30
20. De Virgaliis S, Sanna G, Cornacchia G, Argiolu F, Murgia V, Porcu M, Cao a.Serum ferritin, liver iron stores and liver histology in children with thalassemia.Arch Dis Child.1980 Jan;55(1):43-5
21. De Virgaliis S, Sanna G, Cornacchia G, Argiolu F, Cossu P.Chronic liver disease in transfusion dependent thalassemia. Liver iron quantification and distribution.Acta Hematol.1981;65(1):32-9
22. Davis RJ,Covera S,Czech MP.Insulin stimulates cellular iron uptake and causes the redistribution of intracellular transferrin receptors to the plasma membrane.J Biol Chem.1986;261:8708-8711.
23. Dandona P, Hussian MAM, Varghese Z, Politis D, Flynn DM.Insulin resistance and iron overload.Ann Clin Biochem,1983 Mar;20 pt2:77-9
24. De sanctis V, D Ascola G, Wonke B.The development of diabetes and chronic liver disease in long term chelated beta thalassemia patients. Postgrad Med j,1986 Sep;62(731):831-6
25. Principles and practice of medicine.19^th edition; Ch22:pg 1162
26. El Hazmi MA, Al Fawaz I, Warry AS.Iron endocrine patterns with thalassemia.J Trop Pediatr.1994;Aug;40(4):219-24
27. El Hazmi MA, Al Fawaz, Al Swailem. Diabetes mellitusrecurrent depression: a randomized, placebo controlled trial. Clin. Psychiatry 67, 1767–1775 (2006).
28. David g., Inmaculada gilaberte, Fujun wang. Duloxetine in the prevention of relapse of major depressive disorder: double-blind placebo-controlled study. British journal of psychiatry (2 0 0 6), 1 8 8 , 3 4 6 - 3 5 3).
29. Rouillon F, Warner B, Pezous N, et al. Milnacipran efficacy in the prevention of recurrent depression: A 12-month placebo-controlled study. Int Clin Psychopharmacol. 2000;15(3):133–140).

Dr Prachi Gupta (Goyal)

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.