A MULTICENTER ICET-A SURVEY ON ADHERENCE TO ANNUAL ORAL GLUCOSE TOLERANCE TEST (OGTT) SCREENING IN TRANSFUSION-DEPENDENT THALASSEMIA (TDT) PATIENTS - THE EXPERT CLINICIANS’ OPINION ON FACTORS INFLUENCING THE ADHERENCE AND ON ALTERNATIVE STRATEGIES FOR ADHERENCE OPTIMIZATION Survey on adherence to annual OGTT in thalassemia
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Keywords
: Transfusion-dependent thalassemia, oral glucose tolerance test, adherence to OGTT, ICET- A Network, implications of OGTT guidelines.
Abstract
Abstract. Background: Current guidelines for screening glucose dysregulation (GD) in patients with transfusion-dependent thalassemia (TDT) recommend an annual 2-hour oral glucose tolerance test (OGTT) starting at the age of 10 years. Objective: Assessment of adherence to OGTT screening in patients with TDT.
Methods: A questionnaire was distributed to 18 Thalassemia Centers in 10 different countries, targeting factors influencing adherence to annual OGTT screening in specialized multidisciplinary pediatric and adult TDT units and identifying strategies to improve adherence to OGTT in TDT patients.
Results: The mean reported percentage of all types of GD across 16 of the 18 centers ,at last OGTT assessment, was 32.0% while the mean percentage for thalassemia-related diabetes mellitus (Th-RDM) was 12.2 ± 9.7% (range: 0% - 41%; median:13.2 % ) in all participating centers. Notably, a high percentage of suboptimal or poor adherence to annual OGTT screening (mean 41.3%; range 10-90%) was reported by 17/18 centers. Poor adherence to annual OGTT among eligible patients was multifactorial, related to both patient-, and healthcare system barriers. The most commonly suggested actions by hematologists and endocrinologists for improving the adherence to OGTT were: flexibility in timing, easy approach to test location, improved collaboration among team members and persistent reminding.
Conclusions: Young adult patients with TDT are at high risk for developing GD and Th-RDM, thus annual screening with a 2-hour OGTT is recommended. Nevertheless, there are several patient barriers associated with low adherence to annual OGTT. It is desirable to develop intensive initiatives to improve screening rate for GD, while studies are warranted to update the current guidelines in TDT patients with low risk factors for GD and for countries with low-resource settings.
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References
2. De Sanctis V, Daar S, Soliman A, Tzoulis P, Yassin MA, Kattamis C. Evolution of combined impaired fasting glucose and impaired glucose tolerance in β-thalassemia major: Results in 58 patients with a mean 7.7- year follow-up. Acta Biomed. 2022; 93(3): e2022242. https://doi. org/10.23750/abm.v93i3.12825,
3. He LN, Chen W, Yang Y, Xie YJ, Xiong ZY, Chen DY, Liu NQ, Yang YH, Sun XF. Elevated Prevalence of Abnormal Glucose Metabolism and Other Endocrine Disorders in Patients with β-Thalassemia Major: A Meta-Analysis. Biomed Res Int.2019. 2019:6573497. https://doi. org/ 10.1155/2019/6573497.
4. El Sayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Gaglia JL,
Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association . 2. Classification and diagnosis of diabetes: Standards of Care in Diabetes—2023. Diabetes Care. 2023; 46 (Suppl.1):S19–S40. https://doi. org/10. 2337/dc23-S002.
5. De Sanctis V, Soliman A, Tzoulis P, Daar D, Karimi M, Yassin MA, Pozzobon G, Kattamis C. The clinical characteristics, biochemical parameters and insulin response to oral glucose tolerance test (OGTT) in 25 transfusion dependent β-thalassemia (TDT) patients recently diagnosed with diabetes mellitus (DM). Acta Biomed. 2022;92(6):e2021488. https://doi. org/10.23750/ abm.v92i6.12366.
6. De Sanctis V, Soliman AT, Elsedfy H, Skordis N, Kattamis C, Angastiniotis M, Karimi M, Yassin MA, El Awwa A,Stoeva I, Raiola G, Galati MC, Bedair EM, Fiscina B, El Kholy M. Growth and endocrine disorders in thalassemia. The international network on endocrine complications in thalassemia (I-CET) position statement and guidelines. Indian J Endocrinol Metab. 2013;17(1):8-18. https://doi. org/ 10.4103/2230-8210.107808.
7. De Sanctis V, Soliman AT, Daar S, Tzoulis P, Di Maio S, Kattamis C. Oral glucose tolerance test: how to maximize its diagnostic value in children and adolescents. Acta Biomed. 2022; 93(5): e2022318. https://doi.org/10. 23750/abm.v93i5.13615.
8. De Sanctis V, Soliman A, Tzoulis P, Daar S, Pozzobon G, Kattamis C. A study of isolated hyperglycemia (blood glucose ≥155 mg/dL) at 1-hour of oral glucose tolerance test (OGTT) in patients with β-transfusion dependent thalassemia (β-TDT) followed for 12 years. Acta Biomed. 2021;92(4): e2021322.https://doi. org/ 10.23750/ abm.v92i4.11105.
9. Campisi S, De Sanctis V, Soliman A, Daar S, Kattamis C.The credibility of intermediate hyperglycemia (IH) at one hour of OGTT in 30 β-thalassemia patients (β-thal) with persistent low iron overload. Acta Biomed. 2024;95 (4): e2024137. https://doi. org/10.23750/abm.v95i4.16137.
10. De Sanctis V, Soliman A, Daar S, Tzoulis P, Karimi M, Saki F, Di Maio s, Kattamis C. A prospective guide for clinical implementation of selected OGTT-derived surrogate indices for the evaluation of β-cell function and insulin sensitivity in patients with transfusion-dependent β-thalassaemia. Acta Biomed. 2023; 94(6): e2023221. https://doi.org/ 10. 23750/abm.v94i6.15329.
11. Hicks R, Ode KL, Vigers T, Chan CL. A provider survey of cystic fibrosis related diabetes
screening and management practices at North American CF centers. Front Endocrinol.2023;14:1183288.
https://doi.org/10.3389/fendo.2023.1183288.
12. Korner A, Wiegand S, Hungele A, Tuschy S, Otto KP, l'Allemand-Jander D, Widhalm K, Kiess W, Reinhard H. Longitudinal multicenter analysis on the course of glucose metabolism in obese children. Int J Obes (Lond). 2013;37(7):931–6. https://doi.org/ 10. 1038/ ijo.2012.163.
13. Hillier TA, Pedula KL, Ogasawara KK, Vesco KK, Oshiro CES, Lubarsky SL, Van Marter J. A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. N Engl J Med. 2021;11;384 (10):895-904. https://doi.org/ 10.1056/NEJMoa2026028.
14.Khamseh M E, Malek M, Hashemi-Madani N, Ghassemi F, Rahimian N, Ziaee A, Foroughi-Gilvaee M, Faranoush P, Sadighnia O, Elahinia A, Saeedi V, MR, Faranoush M. Guideline for the diagnosis and treatment of diabetes mellitus in patients with transfusion-dependent thalassemia. Iranian J Blood Cancer. 2023;15 (4):293-303.http:// doi.org/ijbc.ir/article-1-1424-en.html.
15. Bowling, Ann . Measuring Disease: A Review of Disease-Specific Quality of Life Measurement Scales. Philadelphia: Open University Press/Taylor & Francis. 1995; pp. 1-374. http://hdl.handle.net/ 10822/ 1037305. Last Update: December 18, 2023.
16.Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ.1986;5(1):1–30. https://doi. org/10.1016/0167-6296(86)90020-2.
17. Pepe A, Pistoia L, Gamberini MR, Cuccia L, Peluso A, Messina G, Spasiano A, Allò M, Bisconte MG, Putti MC, Casini T, Dello Iacono N, Celli M, Vitucci A, Giuliano P, Peritore G, Renne S, Righi R, Positano V, De Sanctis V, Meloni A. The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications inThalassemia Major: A Large, Multicenter Observational Study Diabetes Care. 2020; 43: 2830–2839.https://doi.org/10.2337/dc20-0908.
18. Noetzli LJ, Mittelman SD, Watanabe RM, Coates TD, Wood JC. Pancreatic iron and glucose dysregulation in thalassemia major. Am J Hematol. 2012;87:155–160. https://doi.org/ 10.1002/ajh.22223.
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