Introduction: A number of studies reported that almost every fifth patient with thalassemia hav e diabetes. Various factors could contribute to inadequate retrograde glycemic control in thalassemia patients co-existed with diabetes. According to published data, HbA1C seems to be an insufficient marker of the quality of diabetes control in thalassemia patients.
Case report: We present a male 67 years old type 2 diabetes patient with disease history for 15 years, who is under oral treatment and has microvascular diabetes complications on peripheral nerves and small distal arterial vessels. A retrograde glycemic control determined by HbA1C measurement was unexpectedly satisfied. The patient has been admitted to the hospital because of chronic distal neuropathic pain, right toe trophic ulcer, and electromyography (EMG) finding of distal sensorimotor polyneuropathy. In past medical history, the patient reported a discus hernia (L1-5) surgery and later on noticed the presence of blood transfusions-independent thalassemia. Additionally, his daughter is also a beta thalassemia-heterozygous carrier. Five-point glycemic profile revealed moderate postprandial hyperglycemia and no hypoglycemic episodes. Despite the fact of already EMG confirmed distal polyneuropathy, retrograde glycemic control was optimal (HbA1C 6.5%). The thorough patient examination did not reveal any other chronic micro- or macrovascular diabetes complication. Laboratory analyses show microcytic anemia, mild biochemical syndrome of liver necrosis and remodeling and moderate hepatosplenomegaly detected by abdominal ultrasound. After the introduction of insulin and treatment by hyperbaric oxygen, the patient was discharged slightly improved in regard to actual glycemic control and right toe trophic ulcer healing. Some neuropathic complaints alleviation was achieved by use of alpha lipoic acid, pregabalin and amitriptyline.
Discussion and conclusion: When different factors can interfere with HbA1C measurements in diseases such as thalassemia and hemoglobinopathies, the discrepant findings of profile glycemic control and HbA1C values could be expected. In such patients, it is necessary to measure HbA1C with another method or to use fructosamine as a more reliable marker of retrograde glycemic control. When the 5-point glycemic profile is acceptable, HbA1C can be cautiously used in the estimation of retrograde glycemic control, preferably accompanied by fructosamine.
18 - 21 May 2019
European Society of Endocrinology