Evaluation of continuous glucose monitoring system for detection of alterations in glucose homeostasis in pediatric patients with β-thalassemia major

Background Disturbances of glucose metabolism are common in beta-thalassemia major (beta-TM). Aim This study was conducted to assess the pattern of glucose homeostasis in pediatric beta-TM patients comparing oral glucose tolerance test (OGTT) and continuous glucose monitoring system (CGMS). Methods Two-hundred beta-TM patients were studied and those with random blood glucose (RBG) >= 7.8 mmol/L (140 mg/dL) were subjected to OGTT, insertion of CGMS and measurement of fasting C peptide, fasting insulin, and hemoglobin A1c (HbA1c). Results Twenty patients (10%) had RBG >= 7.8 mmol/L. Using OGTT, 6 out of 20 patients (30%) had impaired glucose tolerance (IGT) while 7 (35%) patients were in the diabetic range. CGMS showed that 7/20 (35%) patients had IGT and 13 (65%) patients had diabetes mellitus (DM); 10 of the latter group had HbA1c readings within diabetic range. The percentage of diabetic patients diagnosed by CGMS was significantly higher than that with OGTT (P = 0.012). Serum ferritin was the only independent variable related to elevated RBG. All beta-TM patients with DM were non-compliant to chelation therapy. Conclusions The use of CGMS in the diagnosis of early glycemic abnormalities among pediatric patients with beta-TM appears to be superior to other known diagnostic modalities.