Original Articles
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases
https://doi.org/10.4084/MJHID.2026.035

THE IMPACT OF PRE-ANALYTICAL FACTORS ON BLOOD GLUCOSE MEASUREMENTS AND  and recommendations THE IMPACT OF PRE-ANALYTICAL FACTORS ON BLOOD GLUCOSE MEASUREMENTS AND RECOMMENDATIONS  FOR CLINICAL PRACTICE: AN ICET-A MULTICENTER SURVEY IN TRANSFUSION-DEPENDENT Β THALASSEMIA (Β-TDT) PATIENTS

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Published: April 30, 2026
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Dysglycemia, Thalassemia-Related Diabetes Mellitus, OGTT, Pre-analytical factors, Blood glucose measurements, ICET-A Network.

Authors

Vincenzo De Sanctis
vdesanctis@libero.it
Accredited Private Hospital Quisisana, Italy.
Christos Kattamis
First Department of Pediatrics, National Kapodistrian University of Athens, Greece, Greece.
Duran Canatan
Antalya Bilim University and Antalya Genetic Diseases Assessment Center, Antalya, Türkiye durancanatan@gmail.com, Türkiye.
Defne Ay Tuncel
University of Health Sciences Adana City Training and Research Hospital, Department of Pediatric Hematology-Oncology, Adana, Türkiye, Türkiye.
Sule Unal
Hacettepe University, Department of Pediatric Hematology, Ankara,Türkiye , Türkiye.
Dulani Kottahachchi
Hemal’s Thalassaemia Unit, Colombo North Teaching Hospital, Colombo, Sri Lanka, Sri Lanka.
Mohamed A Yassin
Head of Hematology Department, Hamad Medical Corporation, Professor of Hematology, College of Medicine, Qatar University, Doha, Qatar, Qatar.
Ashraf T Soliman
Department of Pediatric Division of Endocrinology, Hamad General Hospital, Doha, Qatar, Qatar.
Saif Al Yaarubi
Child Health Department, Sultan Qaboos University, College of Medicine and Health Sciences, and University Medical City, Muscat, Sultanate of Oman, Oman.
Yasser Wali
Child Health Department, Sultan Qaboos University, College of Medicine and Health Sciences, and University Medical City, Muscat, Sultanate of Oman, Oman.
Mehran Karimi
Pediatric Hematology Oncology Department, American Hospital, Dubai, UAE, Iran, Islamic Republic of.
Forough Saki
Shiraz Endocrinology and Metabolism Research Center, Shiraz, Iran, Iran, Islamic Republic of.
Mohammad Faranoush
Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of.
Polyxeni Delaporta
Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), ‘Aghia Sophia’ Children’s Hospital, ERN-EuroBloodNet Center, Athens, Greece, Greece.
Antonis Kattamis
Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), ‘Aghia Sophia’ Children’s Hospital, ERN-EuroBloodNet Center, Athens, Greece, Greece.
Iskra Modeva
Laboratory of Neonatal Screening and Functional Endocrine Diagnostic, University Pediatric Hospital "Prof. Ivan Mitev", Medical University Sofia, Bulgaria , Bulgaria.
Ploutarchos Tzoulis
Department of Diabetes and Endocrinology, Whittington Hospital, University College London, London, UK, United Kingdom.
Shahina Daar
Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman, Oman.
Irene Savvidou
Thalassemia Unit, Nicosia, Cyprus, Cyprus.

Abstract. Background: During the last few decades, screening for dysglycemia in transfusion-dependent β-thalassemia patients (β-TDT) with an oral glucose tolerance test (OGTT) using fasting (FPG) and 2-hour plasma glucose (2h-PG) samples has been recommended at 10, 12, 14, and 16 years and annually thereafter. A precise measurement of blood glucose (BG) concentration is the mainstay for an accurate diagnosis of dysglycemia, in order to limit the risk of false-positive (i.e., overdiagnosis) and false-negative (i.e., underdiagnosis) results, especially in patients with BG values near the cut-off values.

Research objective: The primary objective of our survey was to describe the procedures followed during the pre-analytical phase of screening for dysglycemia, based on the actual clinical practice of Centers following β-TDT patients. Answers from the survey were compared with international recommendations (American Diabetes Association and World Health Organization).

Methods: This observational study was based on an online questionnaire survey.  All members of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescent Medicine (ICET-A) were officially invited. The questionnaire consisted of  6 sections and 22 questions, including single-choice, multiple-choice, and open-ended descriptive answers.

Results: 14 out of 18 invited Centers [Bulgaria, Cyprus, Greece, Iran (2), Italy (2), Oman, Qatar, Sri Lanka, Türkiye (3) and  United Kingdom] accepted and completed the survey promoted by the ICET-A with a response rate of  77.7 % The total number of β-TDT patients followed in the participating Centers was 3,372 and 2,932 (86.9 %) were over the age of 10 years. The total number of  thalassemia related diabetes mellitus (Th-RDM) reported by all Centers was 549. The total mean prevalence of  Th-RDM was 14.7 ± 10.2 % . Generally, the survey has shown that there was a variable adherence to, and deviations from, current international guidelines. The lowest adherence rate regarded the information and instructions given to patients prior to OGTT (~56%), and how the BG samples were stored from the time of collection to time of centrifugation and analysis (~80 %). Differences in  these factors may result in unintended variations in the prevalence of dysglycemia and have important implications for clinical practice.

Conclusions: Many factors across the total testing process (sample collection, storage and transport during the preanalytical phase) can significantly impact OGTT accuracy and reproducibility, especially in patients with blood glucose values closer to the cut-off values. To minimize pre-analytical errors, a more precise diagnostic approach associated with closer patient follow-up is  needed to reduce  the risk of errors in glucose measurement.

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“THE IMPACT OF PRE-ANALYTICAL FACTORS ON BLOOD GLUCOSE MEASUREMENTS AND  and recommendations THE IMPACT OF PRE-ANALYTICAL FACTORS ON BLOOD GLUCOSE MEASUREMENTS AND RECOMMENDATIONS  FOR CLINICAL PRACTICE: AN ICET-A MULTICENTER SURVEY IN TRANSFUSION-DEPENDENT Β THALASSEMIA (Β-TDT) PATIENTS” (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1). doi:10.4084/MJHID.2026.035.
Copyright (c) 2026 Vincenzo De Sanctis, Christos Kattamis, Duran Canatan, Defne Ay Tuncel, Sule Unal , Dulani Kottahachchi, Mohamed A Yassin, Ashraf T Soliman, Saif Al Yaarubi , Yasser Wali, Mehran Karimi, Forough Saki, Mohammad Faranoush, Polyxeni Delaporta, Antonis Kattamis, Iskra Modeva, Ploutarchos Tzoulis, Shahina Daar, Irene Savvidou Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.