@article{De Sanctis_2021, title={FIRST-PHASE INSULIN RESPONSE (FPIR) TO INTRAVENOUS GLUCOSE TOLERANCE TEST (IVGTT), INSULIN SENSITIVITY AND LONG-TERM FOLLOW-UP IN TRANSFUSION-DEPENDENT BETA-THALASSEMIA (TDT) NORMOGLYCEMIC PATIENTS WITH REDUCED INSULIN SECRETION TO ORAL GLUCOSE TOLERANCE TEST: A PILOT STUDY.: The function of the endocrine pancreas in transfusion-dependent ?-thalassemia}, volume={13}, url={https://www.mjhid.org/mjhid/article/view/4494}, DOI={10.4084/mjhid.2021.021}, abstractNote={<p><span style="font-family: Times New Roman;"><span style="font-size: medium;"><strong><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Summary. Objective</span></strong><span lang="EN-GB" style="mso-ansi-language: EN-GB;">: </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: Times-Roman;"><span style="font-size: medium;">To<span style="mso-spacerun: yes;">  </span></span><span style="font-size: medium;">study </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;">the function of the endocrine pancreas in transfusion-dependent </span></span><span style="font-size: medium;">?</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;">-thalassemia (</span></span><span style="font-size: medium;">?</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;">-TDT) patients with normal oral glucose tolerance test (OGTT) and hypoinsulinemia. <strong>Patients and methods: </strong></span><span style="font-size: medium;">Seven ?-TDT patients</span><span style="mso-spacerun: yes;"><span style="font-size: medium;">  </span></span><span style="font-size: medium;">(mean age </span><span style="color: black;"><span style="font-size: medium;">22.4 </span></span></span><span style="font-size: medium;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: TimesNewRomanPSMT;">±</span> </span><span lang="EN-GB" style="color: black; font-size: 11pt; font-weight: normal; mso-ansi-language: EN-GB; mso-bidi-font-size: 12.0pt;">4.2 </span><span style="font-size: medium;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">years) with normal glucose tolerance test (NGT) and poor insulin response (</span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: HelveticaNeueLTStd-Cn;">hypoinsulinemia) to OGTT,<span style="mso-spacerun: yes;">  </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;">not associated with </span></span><span style="font-size: medium;">?</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;">-cell autoimmunity, were referred for a second opinion to an Italian Centre, part of the <span style="background: white; color: black;">International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A)</span></span><span style="font-size: medium;">. In this pilot study,</span><span style="mso-spacerun: yes;"><span style="font-size: medium;">  </span></span><span style="font-size: medium;">the first-phase insulin response (FPIR), expressed as the sum of 1 and </span><span style="mso-spacerun: yes;"><span style="font-size: medium;"> </span></span><span style="font-size: medium;">3 minutes insulin, of </span></span><span style="font-size: medium;">?</span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;">-TDT patients to intravenous glucose tolerance test (IVGTT), was tested. Moreover, the long-term natural history was followed prospectively using an annual OGTT, with the aim of detecting any abnormality of glucose metabolism.<strong> Results: </strong></span><span style="font-size: medium;">The FPIR value</span><span style="mso-spacerun: yes;"><span style="font-size: medium;">  </span></span><span style="font-size: medium;">was between the 1st and 3rd percentile in two patients and between the 3rd and 10th percentile in</span><span style="mso-spacerun: yes;"><span style="font-size: medium;">  </span></span><span style="font-size: medium;">five. After </span><span style="color: black;"><span style="font-size: medium;">43 </span></span></span><span style="font-size: medium;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: TimesNewRomanPSMT;">± </span></span><span lang="EN-GB" style="color: black; font-size: 11pt; font-weight: normal; mso-ansi-language: EN-GB; mso-bidi-font-size: 12.0pt;">26 months (range 11 - 80 months) of </span><span style="font-size: medium;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">follow-up, 2 patients developed impaired glucose tolerance (IGT), 3 both IGT and impaired fasting glucose (IFG) and two overt diabetes mellitus (DM). Interestingly, the patients who developed DM had, at baseline the lowest value of insulinogenic index (IGI, 0.08 and 0.25), defined as the ratio of the increment of plasma insulin to plasma glucose during the first 30 minutes after OGTT. Moreover, a significant correlation was found between the IGI at baseline and at follow-up in the patients who developed IGT with or without IFG (R= 0.927; P: 0.023).</span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: MinionPro-Regular;"> A significant reduction of </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;">Matsuda insulin sensitivity index (ISIM) <span style="color: black;">and </span></span><span style="font-size: medium;">Insulin Secretion-Sensitivity Index-2 (ISSI-2)</span></span><span style="font-size: medium;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: MinionPro-Regular;"> was documented in the study cohort at diagnosis of IFG, IGT and DM.</span> </span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: MinionPro-Regular;"><span style="font-size: medium;">There was a significant inverse correlation between ISSI-2 and area under the curve of plasma glucose (AUC-PG). <strong>Conclusions: </strong></span><span style="font-size: medium;">These data demonstrated, for the first time, a progressive deterioration in glucose homeostasis in </span></span><span style="font-size: medium;">?</span><span style="font-size: medium;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">-TDT</span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: MinionPro-Regular;"> subjects </span><span lang="EN-GB" style="mso-ansi-language: EN-GB;">with NGT and hypoinsulinemia. </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-fareast-font-family: MinionPro-Regular;"><span style="mso-spacerun: yes;"><span style="font-size: medium;"> </span></span><span style="font-size: medium;">Thus, we consider </span></span><span lang="EN-GB" style="color: black; mso-ansi-language: EN-GB;"><span style="font-size: medium;">that</span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><span style="font-size: medium;"> variations of insulin sensitivity </span><span style="font-size: medium;">could possibly have an impact on glucose tolerance in adult patients with TDT. Further investigations should focus on factors that might positively influence insulin sensitivity, including nutrition, drugs and physical activity.</span></span></span></p> <p> </p>}, number={1}, journal={Mediterranean Journal of Hematology and Infectious Diseases}, author={De Sanctis, Vincenzo}, year={2021}, month={Feb.}, pages={e2021021} }