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Zinc status affects glucose homeostasis and insulin secretion in patients with thalassemia.

Fung EB, Gildengorin G, Talwar S, Hagar L, Lal A - Nutrients (2015)

Bottom Line: Up to 20% of adult patients with Thalassemia major (Thal) live with diabetes, while 30% may be zinc deficient.Charts from thirty subjects (16 male, 27.8 ± 9.1 years) with Thal were reviewed.Taken together, these data suggest that the frequently present zinc deficiency in Thal patients is associated with decreased insulin secretion and reduced glucose disposal.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology/Oncology at the UCSF Benioff Children's Hospital, 747 52nd Street Oakland, CA 94609, USA. efung@mail.cho.org.

ABSTRACT
Up to 20% of adult patients with Thalassemia major (Thal) live with diabetes, while 30% may be zinc deficient. The objective of this study was to explore the relationship between zinc status, impaired glucose tolerance and insulin sensitivity in Thal patients. Charts from thirty subjects (16 male, 27.8 ± 9.1 years) with Thal were reviewed. Patients with low serum zinc had significantly lower fasting insulin, insulinogenic and oral disposition indexes (all p < 0.05) and elevated glucose response curve, following a standard 75 g oral load of glucose compared to those with normal serum zinc after controlling for baseline (group × time interaction p = 0.048). Longitudinal data in five patients with a decline in serum zinc over a two year follow up period (-19.0 ± 9.6 μg/dL), showed consistent increases in fasting glucose (3.6 ± 3.2 mg/dL) and insulin to glucose ratios at 120 min post glucose dose (p = 0.05). Taken together, these data suggest that the frequently present zinc deficiency in Thal patients is associated with decreased insulin secretion and reduced glucose disposal. Future zinc trials will require modeling of oral glucose tolerance test data and not simply measurement of static indices in order to understand the complexities of pancreatic function in the Thal patient.

No MeSH data available.


Related in: MedlinePlus

(a) Blood glucose response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Values above are mean blood glucose ± SEM. (b) Serum insulin response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Insulin values above are raw means ± SEM.
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nutrients-07-04296-f003: (a) Blood glucose response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Values above are mean blood glucose ± SEM. (b) Serum insulin response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Insulin values above are raw means ± SEM.

Mentions: The effect of decline in serum zinc over time on OGTT was analyzed in five subjects (three female). Over an average period of two years, serum zinc decreased by 19.0 ± 9.6 μg/dL (p = 0.01, Table 2) and serum copper by 24.2 ± 18.7 μg/dL (p = 0.08). Chelation dosages were increased markedly during this time interval for one patient in response to rising iron load, while one other subject started growth hormone therapy. Overall, the effect of developing zinc deficiency on OGTT response measured by paired samples was different from the cross-sectional group. An increase in blood glucose manifesting as 7% increase in glucose AUC was observed in Visit 2 compared to Visit 1 (Figure 3a) while insulin AUC increased by 67% (Figure 3b). The pre-visit differed from the post-visit insulin response to the OGTT (after controlling for time post glucose load in a repeated measures ANOVA model, p = 0.035). ISI decreased from an average (±SD) of 9.9 ± 4.8 to 6.0 ± 1.6 (p = 0.11) with no change in HOMA-IR. Moreover, both the fasting blood glucose (p = 0.06) and the ratio of insulin/glucose at the final time point of the OGTT (120 min, p = 0.05) consistently increased in all patients as serum zinc dropped.


Zinc status affects glucose homeostasis and insulin secretion in patients with thalassemia.

Fung EB, Gildengorin G, Talwar S, Hagar L, Lal A - Nutrients (2015)

(a) Blood glucose response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Values above are mean blood glucose ± SEM. (b) Serum insulin response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Insulin values above are raw means ± SEM.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488784&req=5

nutrients-07-04296-f003: (a) Blood glucose response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Values above are mean blood glucose ± SEM. (b) Serum insulin response to a 75-g oral glucose load in n = 5 patients with Thalassemia who had a decline in serum zinc, measured at two separate visits, two years apart. Insulin values above are raw means ± SEM.
Mentions: The effect of decline in serum zinc over time on OGTT was analyzed in five subjects (three female). Over an average period of two years, serum zinc decreased by 19.0 ± 9.6 μg/dL (p = 0.01, Table 2) and serum copper by 24.2 ± 18.7 μg/dL (p = 0.08). Chelation dosages were increased markedly during this time interval for one patient in response to rising iron load, while one other subject started growth hormone therapy. Overall, the effect of developing zinc deficiency on OGTT response measured by paired samples was different from the cross-sectional group. An increase in blood glucose manifesting as 7% increase in glucose AUC was observed in Visit 2 compared to Visit 1 (Figure 3a) while insulin AUC increased by 67% (Figure 3b). The pre-visit differed from the post-visit insulin response to the OGTT (after controlling for time post glucose load in a repeated measures ANOVA model, p = 0.035). ISI decreased from an average (±SD) of 9.9 ± 4.8 to 6.0 ± 1.6 (p = 0.11) with no change in HOMA-IR. Moreover, both the fasting blood glucose (p = 0.06) and the ratio of insulin/glucose at the final time point of the OGTT (120 min, p = 0.05) consistently increased in all patients as serum zinc dropped.

Bottom Line: Up to 20% of adult patients with Thalassemia major (Thal) live with diabetes, while 30% may be zinc deficient.Charts from thirty subjects (16 male, 27.8 ± 9.1 years) with Thal were reviewed.Taken together, these data suggest that the frequently present zinc deficiency in Thal patients is associated with decreased insulin secretion and reduced glucose disposal.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology/Oncology at the UCSF Benioff Children's Hospital, 747 52nd Street Oakland, CA 94609, USA. efung@mail.cho.org.

ABSTRACT
Up to 20% of adult patients with Thalassemia major (Thal) live with diabetes, while 30% may be zinc deficient. The objective of this study was to explore the relationship between zinc status, impaired glucose tolerance and insulin sensitivity in Thal patients. Charts from thirty subjects (16 male, 27.8 ± 9.1 years) with Thal were reviewed. Patients with low serum zinc had significantly lower fasting insulin, insulinogenic and oral disposition indexes (all p < 0.05) and elevated glucose response curve, following a standard 75 g oral load of glucose compared to those with normal serum zinc after controlling for baseline (group × time interaction p = 0.048). Longitudinal data in five patients with a decline in serum zinc over a two year follow up period (-19.0 ± 9.6 μg/dL), showed consistent increases in fasting glucose (3.6 ± 3.2 mg/dL) and insulin to glucose ratios at 120 min post glucose dose (p = 0.05). Taken together, these data suggest that the frequently present zinc deficiency in Thal patients is associated with decreased insulin secretion and reduced glucose disposal. Future zinc trials will require modeling of oral glucose tolerance test data and not simply measurement of static indices in order to understand the complexities of pancreatic function in the Thal patient.

No MeSH data available.


Related in: MedlinePlus