Hyperferritinemia and dysmetabolic iron overload in the formation of carbohydrate metabolism disorders in overweight and obese patients

BACKGROUND: Diseases, which pathogenesis is based on iron overload - hereditary hemochromatosis, β-thalassemia, porphyria cutanea tarda - are associated with type 2 diabetes mellitus; this suggests the role of excess iron in the formation of carbohydrate metabolism disorders (CMD). The question of the possibility and informative content of using traditional ferrokinetics parameters as predictors and markers for diagnosing various CMD remains debatable.

AIM: To establish relationships between ferrokinetics markers and indicators of carbohydrate metabolism in overweight and obese individuals. The scientific hypothesis is that disturbances in ferrokinetics, such as dysmetabolic iron overload, influence the risk of induction and progression of CMD, regardless of body mass index.

MATERIALS AND METHODS: Patients underwent anthropometry, blood sampling with the determination of a detailed biochemical analysis, lipid spectrum analysis, a detailed general blood test and biochemical indicators of iron metabolism. Taking into account the technical capabilities of the device, a number of patients included in the study underwent T2*-magnetic resonance relaxometry of the liver.

RESULTS: The study included 108 patients, stratified into groups depending on the presence of CMD (without CMD, with impaired glucose tolerance (IGT) and with T2DM), as well as depending on the iron metabolism (with relatively high and relatively low ferritin levels). Ferritin levels were significantly higher in patients with T2DM than in patients with IGT (298.10 [145.80–336.95] and 124.00 [58.30–170.55] ng/ml, respectively, p=0.029) and persons without CMD (59.80 [24.10–108.85] ng/ml, p=0.002), and significantly higher in persons with IGT compared to patients without CMD (p=0.035). Patients with ferritin levels above the 75th percentile had higher glycated hemoglobin levels (HbA1c) (5.8 [5.3–6.6] and 5.4 [5.2–5.7]%, respectively, p=0.016). Ferritin was highly informative in the diagnosis of T2DM: sensitivity 77.8%, specificity 91% with a diagnostic threshold of 208.1 ng/ml (area under the curve = 0.813; p=0.002). In diagnosing IGT ferritin had a high sensitivity of 75% and specificity of 84.4%, but with a lower diagnostic threshold of 126.65 ng/ml (area under the curve = 0.738; p=0.016).

CONCLUSION: The level of hyperferritinemia increases as dysglycemia progresses. Ferritin is a promising marker that is highly informative in the diagnosis of various carbohydrate metabolism disorders.

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