ASSOCİATİON BETWEEN IRON OVERLOAD AND GLUCOSE METABOLİSM İN CHİLDREN AND YOUTH WİTH TRANSFUSİON-DEPENDENT BETA THALASSEMİA: THE ROLE OF CHELATİON THERAPY

Background: Transfusion-dependent thalassemia (TDT) is a transfusion-dependent anemia frequently associated with iron overload, which may disrupt liver function and glucose metabolism. Objective: This study aimed to evaluate glucose dysregulation and the effects of iron chelation therapy in pediatric TDT patients. Methodology: 23 years) with TDT who were followed at a tertiary-care pediatric hematology center with available oral glucose tolerance test (OGTT) data. Clinical and laboratory data were analyzed, including oral glucose tolerance test (OGTT), serum ferritin, alanine aminotransferase (ALT), glycated hemoglobin (Hb A1c), C-peptide, homeostatic model assessment for insulin resistance (HOMA-IR), abdominal ultrasonography (USG), and liver and cardiac magnetic resonance imaging (MRI). Diagnosis of diabetes mellitus (DM) and prediabetes was based on American Diabetes Association (ADA) criteria. Results: OGTT was performed in 28 patients; impaired fasting glucose (IFG) was observed in 10.7%, impaired glucose tolerance (IGT) in 3.6%, and 85.7% had normal glucose regulation. All received consistent oral chelation with film-coated deferasirox. ALT showed significant correlation with age at chelation onset (r=0.49, p=0.00), C-peptide (r=0.45, p=0.02), and age at diagnosis (r=0.56, p=0.001). Duration of chelation correlated with hepatomegaly severity (r=0.61, p=0.00), 30-minute glucose (r=0.39, p=0.03), and insulin levels at 30 (r=0.37, p=0.04) and 90 minutes (r=0.39, p=0.03). No significant association was found between ferritin and OGTT values (p>0.05). Conclusions: Overt glucose metabolism disorders were uncommon and should be interpreted cautiously. These results highlight the critical role of adherence to chelation and metabolic monitoring to prevent DM in children with TDT.