scholarly journals THE ICET-A RECOMMENDATIONS FOR THE DIAGNOSIS AND MANAGEMENT OF DISTURBANCES OF GLUCOSE HOMEOSTASIS IN THALASSEMIA MAJOR PATIENTS

2016 ◽  
Vol 8 ◽  
pp. 2016058 ◽  
Author(s):  
Vincenzo De Sanctis
Keyword(s):  
Glucose Tolerance ◽  
Glucose Homeostasis ◽  
Glucose Tolerance Test ◽  
Laboratory Data ◽  
Thalassemia Major ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Model Assessment ◽  
Intravenous Glucose ◽  
Diagnosis And Management

Iron overload in patients with thalassemia major (TM) affects glucose regulation, and is mediated by several mechanisms. These include the oxidative damage inflicted by iron on the pancreatic ß -cells and liver cells leading to pancreatic and hepatic dysfunction and insulin resistance. These disturbances have been identified by oral glucose tolerance test (OGTT), euglycemic insulin clamp, homeostatic model assessment (HOMA), intravenous glucose tolerance test (IVGT) and continuous glucose monitoring system (CGMS). A group of endocrinologists, hematologists and paediatricians, members of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A) convened to formulate recommendations for the diagnosis and management of abnormalities of glucose homeostasis in thalassemia major patients on the basis of available evidence from clinical and laboratory data and consensus practice. The results of their work and discussions are described in this article.Key words: Thalassemia major; Glucose homeostasis; Diagnosis; Management; Guidelines 

KOHLENHYDRATSTOFFWECHSEL BEI HYPERTHYREOSE: EINFLUSS EINER THYREOSTATISCHEN THERAPIE AUF ORALE UND INTRAVENÖSE GLUCOSETOLERANZ UND INSULINAKTIVITÄT

1971 ◽  
Vol 67 (2) ◽  
pp. 277-287 ◽  
Author(s):  
E. Nieschlag ◽  
B. Wördehoff ◽  
H. J. Gilfrich ◽  
J. Michaelis ◽  
C. Overzier
Keyword(s):  
Glucose Tolerance ◽  
Carbohydrate Metabolism ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Intravenous Glucose Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Intravenous Glucose ◽  
Intravenous Glucose Tolerance ◽  
Initiation Of Therapy

ABSTRACT The influence of antithyroid therapy on the abnormalities of carbohydrate metabolism observed in hyperthyroidism was investigated in 10 patients. No history of diabetes mellitus was known in the patients or their families. 9 normal persons were taken as a control group. An oral and an intravenous glucose tolerance test were administered prior to and at intervals of 2 and 4 weeks after initiation of therapy. Prior to treatment an inpairment of oral glucose tolerance was observed, whereas the glucose assimilation coefficient in the intravenous glucose tolerance test was normal. Both tests however, revealed a significant rise in insulin values above normal. 2 weeks after initiation of therapy insulin values returned to normal during the intravenous glucose tolerance test. During the oral glucose tolerance test glucose and insulin concentration achieved normal levels only after 4 weeks of treatment. In all patients the abnormalities of carbohydrate metabolism observed were reversible.

Status of Glucose Metabolism and the Factors Affecting It, in Children with Thalassemia Major.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3848-3848
Author(s):  
Anupam Sachdeva ◽  
Satya Prakash Yadav ◽  
Subash C. Arya ◽  
Virender K. Khanna ◽  
Archana D. Arya
Keyword(s):  
Diabetes Mellitus ◽  
Glucose Metabolism ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Age Of Onset ◽  
Thalassemia Major ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Normal Glucose

Abstract Abnormalities of the glucose metabolism are well documented in patients with Thalassemia Major who are frequently transfused and receiving therapy for chelation, due to excess iron deposition in the pancreas. The incidence of abnormalities in the glucose metabolism increase with age, with peak incidence between 16–20 years. The Indian (Asian) population is genetically predisposed to developing type 2 diabetes mellitus which is an additional risk factor for our Thalassemic population. Chelation is suboptimal in most of the patients due to economic reasons and ignorance. Impaired glucose tolerance (IGT) usually precedes the development of frank diabetes mellitus and intensive chelation in those with impaired glucose tolerance test may delay/prevent the onset of diabetes mellitus. Hence it is important to know the glyco-metabolic status of these children. At our Thalassemia endocrinology clinic, glucose tolerance test (GTT) is performed routinely in all subjects with Thalassemia major who have not already developed diabetes to identify the “at risk” population.GTT is performed by drawing a baseline fasting sample for blood glucose, oral glucose was given in a dose of 1.75mg/kg upto a maximum of 75 gms. Blood glucose level is measured 2 hours after oral glucose. According to the WHO criteria, Fasting plasma glucose between 110–126mg/dl is classified as impaired fasting and above 126mg/dl as diabetes. 2-hour plasma glucose value between 140–200mg/dl is classified as impaired glucose tolerance and above 200 mg/dl as diabetes. The purpose of this study was to analyze the status of the glucose metabolism of children and young adults with Thalassemia major who were attending our Thalassemia endocrinology clinic and to compare the factors affecting subjects with an abnormal glucose metabolism with those who have a normal glucose metabolism. The parameters compared were: effect of mean S. ferritin levels, age of onset of chelation and genetic predisposition. Retrospective analysis of our case records was done to determine the prevalence of diabetes and impaired glucose tolerance in children and young adults between 13 and 25 years of age. Of the 33 subjects evaluated, 16 out of 33 (48.5%) subjects had an abnormality of the glucose metabolism. 14/33 subjects (42.4%) had developed diabetes mellitus and 2 had an impaired GTT. Of the 16 affected subjects 9 were males and 7 were females (M:F = 1.28:1). The mean serum ferritin for this group was 5464ng/ml, 5503ng/ml for the diabetic group and 5425 for those with impaired GTT. (Range 2523–10904ng/ml). History of diabetes in a first or second degree relative was positive in 9 subjects(56.25%), negative in 2 and unknown in 5 subjects. Average age of onset of chelation was 8 years in this group. Oral glucose tolerance test was normal in 17/33(51.5%) subjects of which 10 were males and 7 were females (1.42:1). Average serum ferritin was 4747.4ng/ml in the group with a normal glucose tolerance. (1600–8294ng/ml). Family history of diabetes in a first or second degree relative was positive in 8 subjects(47%), negative in 4 and unknown in 5 subjects. Average age of onset of chelation was 6.5 years in the group with normal glucose metabolism. In conclusion of the 33 subjects evaluated, 48.5% had an abnormal glucose metabolism.

scholarly journals The biochemical assessment of insulin resistance

2007 ◽  
Vol 44 (4) ◽  
pp. 324-342 ◽  
Author(s):  
Anwar Borai ◽  
Callum Livingstone ◽  
Gordon A A Ferns
Keyword(s):  
Insulin Resistance ◽  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Model Assessment ◽  
Intravenous Glucose ◽  
Gold Standard Method ◽  
The Metabolic Syndrome ◽  
Increased Risk

Insulin resistance is a common condition, recognized to be a central feature of the metabolic syndrome, and strongly associated with an increased risk of cardiovascular disease and diabetes. The quantitative assessment of insulin sensitivity is not used for routine clinical purposes, but the emerging importance of insulin resistance has led to its wider application to research studies that have examined its pathogenesis, aetiology and consequences. The gold standard method for the determination of insulin sensitivity is the euglycaemic hyperinsulinaemic clamp from which indices of insulin sensitivity can be derived. The clamp technique is both expensive and complex to undertake and has prompted the use of surrogate methods, notably the insulin tolerance test and frequently sampled intravenous glucose tolerance test. Indices may be derived from these methods and correlate well with those derived from clamp studies. Indices can also be derived from measurements made during a standard oral glucose tolerance test and from one-off fasting specimens (e.g. homeostasis model assessment and quantitative insulin sensitivity check index). These indices lend themselves for use in large population studies where a relatively simple, inexpensive assessment is necessary. However, these tests all suffer from important limitations, including poor precision. Insulin resistance is increasingly being assessed in clinical situations, where relatively simple markers are required. Insulin-like growth factor binding protein-1 is an emerging marker which may be useful in this context.

scholarly journals SAT-650 Novel Insights into the Entero-Insular Axis in Fibrocalcific Pancreatic Diabetes: An Isoglycemic Intravenous Glucose Infusion (IIGI) Study from India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
shivendra verma ◽  
Riddhi Das Gupta ◽  
Shajith Anoop S ◽  
Nihal Thomas
Keyword(s):  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Significant Rise ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Intravenous Glucose ◽  
Pancreatic Diabetes ◽  
L Cell

Abstract In tropical countries including India, one of the common causes for young onset diabetes mellitus (DM) is “Fibro Calcific Pancreatic Diabetes” (FCPD) characterized by progressive pancreatic destruction. Despite this, glucagon has been found to be elevated in FCPD (1,2). The L-Cells in gut produce glucagon like peptide- 1 (GLP-1) and oxyntomodulin which are products of glucagon gene, thus raising probability of extra-pancreatic glucagon in FCPD. To test this hypothesis we performed 75grams oral glucose tolerance test (OGTT) followed by IIGI on separate days on nine FCPD and six healthy subjects. The latter procedure ensured matched glucose levels achieved during OGTT. Glucagon and incretins were measured at nine pre-specified time points. We found an increase in L-Cell products: GLP-1 (44.5±9.2pM vs. 12.4±4.5pM, p=0.02) and Oxyntomodulin (1252±350pg/ml vs. 859.8±165pg/ml, p=0.43) along with significant rise in glucagon during OGTT (98.8±13pg/ml vs. 63.4±7pg/ml, p=0.03) despite flat basal & stimulated C-peptide (0.43±0.14ng/ml and 1.09±0.3ng/ml, respectively) and Pancreatic polypeptide (12.3±0.0pg/ml and 14.7±1.7pg/ml, respectively) levels. Paradoxically, gastric inhibitory polypeptide (GIP) levels were low in FCPD (106.8±40.3pg/ml vs. 557.8±96.4pg/ml, p=0.003). We speculate that the hyperglucagonemia is extra-pancreatic (L-Cell) in origin and may also contribute to the dichotomous incretin response in FCPD. References: 1. Yajnik CS, Shelgikar KM, Naik SS, Kanitkar SV, Orskov H, Alberti KG, et al. The ketosis-resistance in fibro-calculous-pancreatic-diabetes. 1. Clinical observations and endocrine-metabolic measurements during oral glucose tolerance test. Diabetes Res Clin Pract. 1992 Feb;15(2):149-56. 2. Dasgupta R, Naik D, Thomas N. Emerging concepts in the pathogenesis of diabetes in fibrocalculous pancreatic diabetes. J Diabetes. 2015 Nov;7(6):754-61.

scholarly journals The neuropeptide 26RFa in the human gut and pancreas: potential involvement in glucose homeostasis

2019 ◽  
Vol 8 (7) ◽  
pp. 941-951 ◽  
Author(s):  
Gaëtan Prévost ◽  
Marie Picot ◽  
Marie-Anne Le Solliec ◽  
Arnaud Arabo ◽  
Hind Berrahmoune ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Glucose Homeostasis ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Blood Levels ◽  
Oral Glucose ◽  
Obese Patients ◽  
Oral Glucose Tolerance ◽  
Gastric Glands

Objective Recent studies performed in mice revealed that the neuropeptide 26RFa regulates glucose homeostasis by acting as an incretin and by increasing insulin sensitivity. However, in humans, an association between 26RFa and the regulation of glucose homeostasis is poorly documented. In this study, we have thus investigated in detail the distribution of 26RFa and its receptor, GPR103, in the gut and the pancreas, and determined the response of this peptidergic system to an oral glucose challenge in obese patients. Design and methods Distribution of 26RFa and GPR103 was examined by immunohistochemistry using gut and pancreas tissue sections. Circulating 26RFa was determined using a specific radioimmunoassay in plasma samples collected during an oral glucose tolerance test. Results 26RFa and GPR103 are present all along the gut but are more abundant in the stomach and duodenum. In the stomach, the peptide and its receptor are highly expressed in the gastric glands, whereas in the duodenum, ileum and colon they are present in the enterocytes and the goblet cells. In the pancreatic islets, the 26RFa/GPR103 system is mostly present in the β cells. During an oral glucose tolerance test, plasma 26RFa profile is different between obese patients and healthy volunteers, and we found strong positive correlations between 26RFa blood levels and the BMI, and with various parameters of insulin secretion and insulin resistance. Conclusion The present data suggest an involvement of the 26RFa/GPR103 peptidergic system in the control of human glucose homeostasis.

Insulin sensitivity in women: a comparison among values derived from intravenous glucose tolerance tests with different sampling frequency, oral glucose tolerance test or fasting

2001 ◽  
pp. 281-287 ◽  
Author(s):  
A Cagnacci ◽  
S Arangino ◽  
A Renzi ◽  
P Cagnacci ◽  
A Volpe
Keyword(s):  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Glucose Tolerance Test ◽  
Polycystic Ovary ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Intravenous Glucose ◽  
Intravenous Glucose Tolerance

OBJECTIVE: To determine the correlation between insulin sensitivity (S(I)) obtained by the minimal model method applied to a frequently sampled (n=33) intravenous glucose tolerance test (FSIGT(33)), and values obtained by reduced FSIGTs, oral glucose tolerance test (OGTT), or fasting. DESIGN: Retrospective analysis on tests performed in prospective studies. METHODS: A total of 78 FSIGT(33), and 59 OGTT were performed in non-diabetic women of which 10 were young cyclic females in the early follicular menstrual phase, 10 were young non-obese subjects with polycystic ovary syndrome (PCOS) and 30 were in post-menopause. Some of these individuals were investigated both prior to and during specified treatments. FSIGT(33) was transformed into FSIGT(22) and FSIGT(12) by removing samples from the analysis. Values of SI derived from reduced FSIGTs or calculations performed on glucose and insulin values observed in fasting conditions and/or during OGTT were related to those of FSIGT(33). RESULTS: S(I) values derived from FSIGT(33) were highly correlated with those derived from FSIGT(22) (r=0.965) or FSIGT(12) (r=0.955), but were only weakly correlated with those derived from fasting or OGTT calculations (r below 0.5). Between-group (PCOS vs normal) or within-group (prior to and during treatment) comparisons showed that reduced FSIGTs were only slightly less powerful than FSIGT(33) in detecting differences in S(I). CONCLUSIONS: In non-diabetic women, reduced FSIGTs but not calculations based on fasting or OGTT values may be used in place of FSIGT(33) to document S(I) and its variation.

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