Investigations:
§ Glucose tolerance tests, insulin levels, insulin resistance index,
beta cell function index should be an integral part of the long term follow up
of thalassemia patients on an annual basis from the second decade onwards
(especially the second half).
§ Iron overload studies, liver function tests should be done
regularly to correlate with the parameters of glucose metabolism (Suvarna
et al., 2006).
§ HbA1C is used routinely to assess long-term glycemic control in
patients with DM. The main limitation of HbA1C measurement is Hb disorders (Camargo
& Gross, 2004). It is noted that measurements of HbA1c by high
performance liquid chromatography and electrophoresis are obviously unsuitable
for homozygous hemoglobinopathy, heterozygous hemoglobinopathy, and Hb synthesis variants (Viroj
Wiwanitkit, 2006).
Monitoring diabetes and its complications:
- Blood
glucose (daily or alternate days).
- Ketones
– check if blood sugar is above 250 mg/dl.
- Fructosamine
estimation is more helpful than glycosylated haemoglobin levels.
- Urinary
glucose is influenced by increased renal glucose threshold.
- Renal
function tests.
- Serum
lipids (cholesterol, HDL, LDL, triglyceride.
- Urinary
protein.
- Evaluation
for retinopathy (De Sanctis, 1998).
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