Glycated Albumin as Marker for Early Hyperglycemia Detection in Adolescent with β Thalassemia Major

Dewinda Candrarukmi, Annang Giri Moelyo, Muhammad Riza

Abstract


BACKGROUND: Hyperglycemia is one of the most common endocrine complications in children with β thalassemia major. Though the current diagnostic marker either requires fasting, has low reproducibility, or it is not an accurate for thalassemia patients. Glycated albumin (GA) is a quick and easy alternative marker for hyperglycemia detection and monitoring of glycemic control. However to date, no studies have analyzed the role of GA value in detection of hyperglycemia in children with thalassemia major. This study analyzed the value of GA as an alternative screening marker for hyperglycemia detection in children with β thalassemia major.

METHODS: A single-blind prospective diagnostic test was conducted in 9 to 18 years old children with β thalassemia major and who were treated at the Dr. Moewardi Regional General Hospital between October 1, 2018 and December 31, 2019. In a single, fasted study visit, height, weight, fasting blood glucose (FPG), GA, oral glucose tolerance test (OGTT) were measured. The area under a receiver operating characteristic curve (AUC) was used to determine the cut-off value at which hyperglycemia prediction (OGTT ≥140 mg/dL) display optimal sensitivity and specificity.

RESULTS: Among the 53 children with β thalassemia major, 1 (1.9%) had diabetes mellitus and 4 (7.5%) had prediabetes based on their OGTT values. The median GA value in this study was 10.9% (range: 7.6–12.4%). GA had a low AUC (0.646, p=0.287) for hyperglycemia detection in pediatric patients with β thalassemia major. At a cut-off of 11.45%, GA demonstrated 60% sensitivity and 60.4% specificity.

CONCLUSION: GA cannot be used as an alternative marker for hyperglycemia detection in children with β thalassemia major.

KEYWORDS: hyperglycemia, diabetes mellitus, prediabetes, β thalassemia major, glycated albumin

 


Full Text:

PDF

References


De P, Mistry R, Wright C, Pachan S, Burbridge W, Gangopadhayay K, et al. A review of endocrine disorder in thalassemia. Open J Endocr Metab Dis. 2014; 4: 25-34, CrossRef.

Al-akhras A, Badr M, El-safy U, Kohne E, Hassan, Abdelrahman H, et al. Impact of genotype on endocrine complication in b-thalassemia patients. Biomed Rep. 2016; 4: 728-36, CrossRef.

Pulungan A. Increasing incidence of DM type 1 in Indonesia. Int J Pediatr Endocrinol. 2013; (Suppl 1): O12,

Sactis VD, Skordis N. Solirhan AT. Chapter 8: Endocrine disease. In: Cappellini MD, Cohen A, Porter J, editors. Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT). 3rd ed. Strovolos: Thalassemia International Federation; 2014. p.151-4, NLMID.

Araki T, Ishikawa Y, Okazaki H. Japanese Red Cross GA Research Group: introduction of glycated albumin measurement for all blood donors and the prevalence of a high glycated albumin level in Japan. J Diabetes Investig. 2012; 3: 492-7, CrossRef.

Selvin E, Rawlings AM, Lutsey P, Maruthur N, Pankow JS, Steffes M, et al. Fructosamine and glycated albumin and the risk of cardiovascular outcomes and death. Circulation. 2015; 132: 269-77, CrossRef.

Paroni R, Ceriotti F, Galanello R, Leoni BG, Panico A, Scurati E, et al. Performance characteristics and clinical utility of an enzymatic method for the measurement of glycated albumin. Clin Biochem. 2007; 40: 1398-405, CrossRef.

Soliman AT, Yasin M, El-awwa A, Sactis VD. Detection of glycemic abnormalities in adolescent with beta thalassemia using continuous glucose monitoring and oral glucose tolerance in adolescents and young adult with b-thalassemia major: pilot study. Indian J Endocrinol Metab. 2013; 17: 490-5, CrossRef.

Metwalley KA, El-saeid ARAH. Glucose homeostasis in egyptian children and adolescent with b-thalassemia mayor: relationship to oxidative stress. Indian J Endocrinol Metab. 2014; 18: 333-9, CrossRef.

Altincik A, Akin M. Prevalence of endocrinopathies in Turkish children with b-thalassemia mayor: a single center study. J Pediatric Hematol Oncol. 2016; 38: 389-93, CrossRef.

Liang Y, Bajoria R, Jiang Y, Su H, Pan H, Xia N, et al. Prevalence of diabetes mellitus in Chinese children with thalassemia major. Trop Med Int Health. 2017; 22: 716-24, CrossRef.

Toumba M, Sergis S, Kanaris C, Skordis N. Endocrine complication in patients with thalassemia major. Pediatric Endocrinol Rev. 2007; 5: 642-8, PMID.

Sharma S, Dutt N, Sidhu M, Digra S, Meenia R. Prevalence of hypothyroidism, diabetes mellitus and delayed puberty in patient of thalassemia major in a tertiary care center of Jammu province, Jammu kashir, India. Int J Adv Med. 2017; 4: 673-7, CrossRef.

Wirawan R, Setiawan S, Kusnandar S, Munthe BG. Diabetes mellitus in b-thalassemia major patients. Med J Indones. 2003; 12: 87-93, CrossRef.

Noetzli LJ, Mittelman SD, Watanabe RM. Pancreatic iron and glucose dysregulation in thalassemia major. Am J Hematol. 2012; 87: 155-60, CrossRef.

De Sanctis V, Soliman A, Yassin M. Iron overload and glucose metabolism in subjects with β-thalassaemia major: An Overview. Curr Diabetes Rev. 2013; 9: 332-41, CrossRef.

Angelopoulos NG, Zervas A, Livadas S. Reduced insulin secretion in normoglycaemic patients with beta-thalassaemia major. Diabet Med. 2006; 23: 1327-31, CrossRef.

Meyer C, Pimenta W, Woerle HJ. Different mechanisms for impaired fasting glucose and impaired postprandial glucose tolerance in humans. Diabetes Care. 2006; 29: 1909-14, CrossRef.

Sanctis VD, Soliman AT, Elsedfy H, Alessia P, Kattamis C, Kholy ME, et al. Diabetes and glucose metabolism in thalassemia major: An Update. Expert Rev Hematol. 2016; 9: 401-8, CrossRef.

Monge L, Pinach S, Caramellino L, Bertero MT, Dall’omo A, Carta Q. The possible role of autoimmunity in the pathogenesis of diabetes in B-thalassemia major. Diabetes Metab. 2001; 27: 149-54, PMID.

Bas M, Gumruk F, Gonc N, Cetin M, Tuncer M, Hazurolan T, et al. Biochemical marker of glucose metabolism may be used to estimate the degree and progression of iron overload in the liver and pancreas of patient with b-thalassemia major. Ann Hematol. 2015; 94: 1099-104, CrossRef.

Aekplakorn W, Tantayotai V, Numsangkul S, Sripho W, Tatsto N, Burapasiriwat T, et al. Detecting prediabetes dan diabetes aggrement between fasting plasma glucose and oral glucose tolerance test in Thai adults. Hindawi. 2015; 2015: 396505, CrossRef.

Kim DL, Kim SD, Song KH. Is an oral glucose tolerance test still valid for diagnosing diabetes mellitus?. Diabetes Metab J. 2016; 40: 118-28, CrossRef.

Abdul-Ghani M, DeFronzo RA, Jayyousi A. Prediabetes and risk of diabetes and associated complications: impaired fasting glucose versus impaired glucose tolerance: does it matter? Curr Opin Clin Nutr Metab Care. 2016; 19: 394-9, CrossRef.

Koga M. Glycated albumin, clinical usefulness. Clin Chim Acta. 2014; 433: 96-104, CrossRef.

Wu WC, Ma WY, Wei JN, Yu TY, Lin MS, Shih SR, et al. Serum glycated albumin to guide the diagnosis of diabetes mellitus. Plos One. 2016; 11: e0146780, CrossRef.

Furusyo N, Koga T, Ai M, Otokozawa S, Kohzuma T, Ikezaki H, et al. Utility of glycated albumin for the diagnosis of diabetes mellitus in a Japanese population study: results from the Kyushu and Okinawa Population Study (KOPS). Diabetologia. 2011; 54: 3028-36, CrossRef.

Bellia C, Zaninotto M, Cosma C, Agnello L, Bivona G, Marinova M. Clinical usefulness of glycated albumin in the diagnosis of diabetes: result from an Italian study. Clin Biochem. 2018; 54: 68-72, CrossRef.

Devi TT, Dalimoenthe NZ, Tristina N, Lismayanti L. Kadar glycated albumin pada penderita transfusion dependent thalassemia di RSUP dr. Hasan Sadikin Bandung. J Indon Med Assoc. 2017; 67: 544-9.

Chan CL, Pyle L, Kelsey M, Newnes L, Zeitler PS, Nadeau KJ. Screening for type 2 diabetes and prediabetes in obese youth: evaluating alternate markers of glycemia- 1,5-anhydroglucitol, fructosamine and glycated albumin. Pediatr Diabetes. 2016; 17: 206-11, CrossRef.

Chume FC, Kieling MH, Camargo JL. Glycated albumin as diagnostic tool in diabetes: an alternative or additional test?. Plos one. 2019; 14: e0227065, CrossRef.

Suzuki S, Koga M, Noriyasu N, Furuya A, Matsuo K, Tanahashi Y, et al. Age-adjusted glycated albumin: a more robust parameter to establish glycaemic control in neonatal diabetes mellitus. Ann Clin Biochem. 2014; 51: 602-5, CrossRef.




DOI: https://doi.org/10.18585/inabj.v13i3.1546

Indexed by:

                 

                  

               

  

 

The Prodia Education and Research Institute