Original Articles
Vol. 17 No. 1 (2025): Review Articles, Original Article, Scientific Letter, Case Reports Letter to the Editor
FASTING PLASMA GLUCOSE LEVELS WITHIN THE HIGH NORMAL RANGE ARE ASSOCIATED WITH A SIGNIFICANTLY INCREASED RISK OF FUTURE DYSGLYCEMIA IN TRANSFUSION-DEPENDENT Β THALASSEMIA: A DECADE-LONG MULTICENTER RETROSPECTIVE ANALYSIS
Higher normal fasting plasma glucose and glucose dysregulation in β- thalassemia
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: July 26, 2025
Accepted: September 30, 2025
Accepted: September 30, 2025
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Abstract. Objective: To evaluate the risk of developing glucose dysregulation and diabetes mellitus over a 10-year period among transfusion-dependent β-thalassemia (β-TDT) patients with varying levels of fasting plasma glucose (FPG) within the normoglycemic range.
Setting: The study included β-TDT patients followed from January 2014 to January 2025 in three thalassemia canters; Tehran and Shiraz in Iran, and Ferrara in Italy.
Participants: A total of 238 β-TDT patients (age range: 10–41.9 years; 96 males and 142 females) were included.
Results: At baseline, the mean fasting plasma glucose (FPG) level was 88.0 ± 8.3 mg/dL (median: 90 mg/dL), and the mean serum ferritin (SF) level was 2,080 ± 2,072 µg/L (median: 1,368 µg/L). The mean alanine aminotransferase (ALT) level, available in 201/238 patients, was 29.0 ± 25.8 IU/L. β-TDT patients were categorized into three subgroups according to the conversion of FPG during the 10 year follow up [Group A: 93/238 β-TDT patients with persistent normal FPG according to ADA criteria; Group B: 67/238 patients developed persistent impaired fasting glucose (IFG), and Group C: 78/238 patients developed thalassemia-related diabetes mellitus (Th-RDM)]. Notably, 64.1% and 76.9 of patients with FPG at baseline ≥ 90 mg/dl and < 100 mg/dL developed impaired fasting glucose (Group B) and Th-RDM (Group C), respectively. To determine the optimal cutoff for the risk of progressing to impaired fasting glucose (IFG) and Th-RDM at 10-year follow-up, ROC curve analyses and respective areas under the curve were analyzed. The FPG cutoff value for optimal specificity and sensitivity was established at 87.5 mg/dL. Contributing factors associated with the progression to prediabetes and Th-RDM included: older age, gender (females), positive family history of type 1 or type 2 diabetes, lower pre-transfusion hemoglobin levels, severity of iron overload, and elevated liver enzyme levels.
Conclusions: Higher FPG levels within the normoglycemic range in β-TDT patients are associated with a greater risk for future glucose dysregulation and diabetes. Close monitoring and timely intervention in these high-risk individuals should be considered in order to reduce the burden of hyperglycemia in this population.
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How to Cite
“FASTING PLASMA GLUCOSE LEVELS WITHIN THE HIGH NORMAL RANGE ARE ASSOCIATED WITH A SIGNIFICANTLY INCREASED RISK OF FUTURE DYSGLYCEMIA IN TRANSFUSION-DEPENDENT Β THALASSEMIA: A DECADE-LONG MULTICENTER RETROSPECTIVE ANALYSIS: Higher normal fasting plasma glucose and glucose dysregulation in β- thalassemia ” (2025) Mediterranean Journal of Hematology and Infectious Diseases, 17(1), p. e2025072. doi:10.4084/MJHID.2025.072.
Copyright (c) 2025 Vincenzo De Sanctis, Forough Saki, Mehran Karimi, Mohammad Faranoush, Ihab Elhakim, Ashraf T Soliman, Shahina Daar, Ploutarchos Tzoulis
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