TY - JOUR
T1 - A prospective guide for clinical implementation of selected OGTT- derived surrogate indices for the evaluation of β- cell function and insulin sensitivity in patients with transfusion-dependent β- thalassaemia
AU - De Sanctis, Vincenzo
AU - Soliman, Ashraf T.
AU - Daar, Shahina
AU - Tzoulis, Ploutarchos
AU - Karimi, Mehran
AU - Saki, Forough
AU - Di Maio, Salvatore
AU - Kattamis, Christos
N1 - Publisher Copyright:
© Mattioli 1885.
PY - 2023/12/5
Y1 - 2023/12/5
N2 - The gold standard for the measurement of insulin secretion is the hyperglycemic clamp and for insulin sensitivity the hyperinsulinemic euglycemic clamp, respectively. A number of surrogate indices, derived from plasma glucose and insulin levels at a fasting state or after oral glucose load, have been proposed to estimate β-cell response, and the ability of β-cells to compensate for changes of insulin sensitivity by modulating insulin secretion (disposition index). Starting from the current recommendations for the annual screening of glucose dysregulation in patients with transfusion dependent β-thalassemia (β-TDT), this article summarizes the most frequently used indirect indices of insulin secretion and resistance derived from the oral glucose tolerance test (OGTT) and discusses the strengths and weaknesses of selected indices and the basic concepts underlying each method for the appropriate evaluation of glucose regulation. Basal indices for β-cell function and insulin sensitivity, albeit simple and cheap, have limited usefulness due to a high coefficient variation and the lack of data about response to glucose load. Therefore, measurement of indices during an OGTT, despite being costly and time-consuming, is suggested since it can detect, even subtle, dynamic changes in insulin secretion and glucose handling. In patients with β-TDT, the indices derived from OGTT may offer an additional factor to evaluate the efficiency of iron chelation therapy and detect patients who may need intensification of iron chelation therapy and/or pharmacological intervention.
AB - The gold standard for the measurement of insulin secretion is the hyperglycemic clamp and for insulin sensitivity the hyperinsulinemic euglycemic clamp, respectively. A number of surrogate indices, derived from plasma glucose and insulin levels at a fasting state or after oral glucose load, have been proposed to estimate β-cell response, and the ability of β-cells to compensate for changes of insulin sensitivity by modulating insulin secretion (disposition index). Starting from the current recommendations for the annual screening of glucose dysregulation in patients with transfusion dependent β-thalassemia (β-TDT), this article summarizes the most frequently used indirect indices of insulin secretion and resistance derived from the oral glucose tolerance test (OGTT) and discusses the strengths and weaknesses of selected indices and the basic concepts underlying each method for the appropriate evaluation of glucose regulation. Basal indices for β-cell function and insulin sensitivity, albeit simple and cheap, have limited usefulness due to a high coefficient variation and the lack of data about response to glucose load. Therefore, measurement of indices during an OGTT, despite being costly and time-consuming, is suggested since it can detect, even subtle, dynamic changes in insulin secretion and glucose handling. In patients with β-TDT, the indices derived from OGTT may offer an additional factor to evaluate the efficiency of iron chelation therapy and detect patients who may need intensification of iron chelation therapy and/or pharmacological intervention.
KW - Transfusion dependent β-thalassemia (β-TDT)
KW - disposition index
KW - insulin secretion
KW - insulin sensitivity
KW - oral glucose tolerance test (OGTT)
KW - recommendations
KW - surrogate indices
KW - Glucose Tolerance Test
KW - Humans
KW - Blood Glucose
KW - Iron
KW - Glucose
KW - Insulin
KW - beta-Thalassemia/therapy
KW - Insulin Resistance/physiology
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UR - https://www.mendeley.com/catalogue/214abce9-8998-3b7a-9356-6c965a720b88/
U2 - 10.23750/abm.v94i6.15329
DO - 10.23750/abm.v94i6.15329
M3 - Article
C2 - 38054665
AN - SCOPUS:85178850244
SN - 0392-4203
VL - 94
SP - e2023221
JO - Acta bio-medica : Atenei Parmensis
JF - Acta bio-medica : Atenei Parmensis
IS - 6
M1 - e2023221
ER -