The Northern California Comprehensive Thalassemia Center Standard of Care Guidelines can be found here: http://thalassemia.com/soc/treatment-guidelines-9.aspx
These guidelines recommend a fasting glucose semi-annually, and if it is greater than 6.1 mmol/L, an oral glucose tolerance test is indicated. In addition a two-hour oral glucose tolerance test should be performed at 10, 12, 14, and 16 years of age and annually thereafter. Further recommendations include that the patient should be referred to endocrinology for management of diabetes mellitus or glucose intolerance and patients diagnosed with glucose intolerance should have their chelation therapy reviewed and intensified (Northern California Comprehensive Thalassemia Center 2012).
The Academy of Medicine of Malaysia has clinical practice guidelines that suggest the early and adequate use of iron chelation can prevent DM, and both DM and impaired glucose tolerance may improve in a third of patients after intensive combined chelation treatment. Use of insulin in a thalassaemia patient with DM isnormally required but metabolic control may be difficult toachieve due to variable pancreatic beta cell function. The use of oral anti-diabetic agents is undetermined (Academy of Medicine Malaysia 2009).
