ArticleMediterranean journal of hematology and infectious diseases2026
Dynamic OGTT-Derived Indices Outperform Fasting HOMA-2 for Detecting Dysglycemia in Transfusion-Dependent β-Thalassemia.
Article in Mediterranean journal of hematology and infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Screening for dysglycemia with an annual oral glucose tolerance test (OGTT) is recommended in transfusion-dependent β-thalassemia (β-TDT), but adherence in routine practice is low. Fasting surrogate indices of β-cell function and insulin sensitivity could offer a less burdensome alternative. Aims: To evaluate in adult β-TDT patients with normal fasting plasma glucose (FPG < 100 mg/dL): (i) the performance of fasting HOMA-2 indices (HOMA2-IR, HOMA2-%β, HOMA2-%S) and their disposition index as predictors of dysglycemia, and (ii) the comparative value of basal versus dynamic OGTT-derived markers (30-min and 1-h plasma glucose, insulinogenic index [IGI], IGI × ISI Methods: A single-centre retrospective analysis of 42 β-TDT patients (19 males/23 females; mean age 29.2 ± 5.9 yr) with FPG < 100 mg/dL who underwent a standard 75-g 2-h OGTT between January 2011 and September 2025. Patients were classified as those with normal glucose tolerance (NGT; n = 19) or those with impaired glucose tolerance (IGT: n= 20) or thalassemia-related diabetes mellitus (Th-RDM: n = 3). Fasting and dynamic indices were compared by ANOVA and Mann-Whitney U test; associations were tested by Pearson/Spearman correlation and by three sequential exploratory multivariable linear regression models with 2-h plasma glucose as the dependent variable. ROC analysis with Youden's index identified optimal hypothesis-generating cut-offs. Results: Fasting HOMA2-IR, HOMA2-%β and HOMA2-%S did not differ significantly between NGT and hyperglycemic patients and were not independent predictors of 2-h plasma glucose. In contrast, in the total group, 30-min PG, 1-h PG, IGI, IGI × ISI Conclusions: Fasting HOMA-2 indices alone are not reliable predictors of dysglycemia in β-TDT patients with PG < 100 mg/dL. The dynamic IGI/HOMA2-IR ratio and the 30-min/1-h post-load plasma glucose may help risk-stratify patients with β-TDT and normal fasting glucose; however, the proposed cut-offs should be regarded as hypothesis-generating, and prospective multicenter validation is required before these indices can be used to modify current OGTT screening recommendations.
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