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Bloodletting improved insulin secretion and sensitivity in a recent trial
Iron depletion reduced liver iron content and improved insulin secretion in carriers of HFE gene mutation.
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Bloodletting improved insulin secretion and insulin sensitivity and decreased liver iron content in carriers of the hemochromatosis gene with and without diabetes, according to recent research.
“In patients with phenotypic appearance of hemochromatosis gene mutations, iron overload is associated with impaired insulin metabolism and features of metabolic syndrome,” researchers wrote in Diabetes Care.
The researchers prospectively examined the effects of bloodletting on insulin sensitivity and secretion, serum biochemical parameters, liver iron content and histology.
They observed nine normal glucose tolerant men and eight men with newly diagnosed diabetes with type 1 hereditary hemochromatosis or heterozygous hemochromatosis. All participants were aged 40 to 60 years. The researchers performed analyses before and after two years of bloodletting. Bloodletting was performed every two weeks by phlebotomy or erythrocytapheresis, according to the study.
“In clinical practice, appropriate selection of patients with diabetes who are likely to benefit from regular phlebotomies may result in the improvement of glucose metabolism,” Melania Manco, MD, PhD, told Endocrine Today. “We believe that for select patients it is essential. Selection may be based mainly on clinical features of iron overload and occurrence of metabolic comorbidities, and not only on genetic testing.”
Manco is from the department of hepato-gastroenterology and nutrition, Bambino Gesù Hospital and Research Institute in Rome, Italy.
Carriers of HFE gene
Manco and colleagues found that ferritin decreased after two years of bloodletting (58.1 ng/mL; P<.0001). Serum iron decreased to 41.0 mg/dL (P<.0001). Liver iron content decreased by 46% in the normal glucose tolerant group and by 35% in the group with diabetes, according to the researchers.
Improvement was observed for parameters including cholesterol (201.2 mg/dL; P<.0001), triglycerides (146.5 mg/dL; P<.0001) and fasting glycemia (94.9 mg/dL; P=.01) in all participants.
Insulin secretion increased by 20% in the normal glucose tolerant group and 33% in the group with diabetes. Insulin sensitivity increased by 25% in the normal glucose group and increased by 18% in the group with diabetes. The insulinogenic index increased by 16% in the normal glucose group compared with the group with diabetes (47%), according to the study.
“Especially important for the prevention of diabetes-related morbidities that can occur very early, this would justify glucose tolerance testing of carriers of HFE gene mutations as well as prophylactic iron depletion in unaffected individuals with diagnosed disease,” the researchers wrote. “The reversibility of iron-related abnormalities in insulin metabolism warrants further investigation.” – by Christen Haigh
For more information:
- Equitani F, Fernandez-Real JM, Menichella G, et al. Bloodletting ameliorates insulin sensitivity and secretion in parallel to reducing liver iron in carriers of HFE gene mutations. Diabetes Care. 2008;31:3-8.