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Insulin resistance (IR) underlies some glucose metabolism abnormalities in thalassemia major. Recently, triglyceride glucose index (TyG) has been proposed for evaluating insulin resistance as a simple, low cost, and accessible tool. In this study, the TyG index were studied for IR monitoring in beta-thalassemia major (βTM) patients. The participants were 90 βTM patients on chronic regular transfusion therapy. The TyG index was computed based on fasting plasma glucose (FPG) and triglyceride (TG). The time gap between the first and the second TyG index survey (TyG.1 and TyG.2) was 2 years. The agreement between TyG and HOMA-IR were studied with the extension of limit of agreement (LOA). We included 90 patients 53.3 % men (n = 48). Among them, 14.4 % (14.6 % male, 14.3 % female) had impaired fasting glucose level (e.g., 100–125 mg/dl) at first test. It rose to 37.8 % (27.1 % male, 50 % female) during 2 years. Based on TyG.1, the 34.4 % of patients was detected as IR cases. After 2 years, the percent of IR based on TyG.2 was 82.2 %. The mean differences between TyG.1 and TyG.2 and their differences from the considered cutoff values were significant (P < 0.001). The prediction limits between TyG and HOMA-IR had good agreement. These data may suggest the use of TyG index for detection/monitoring of IR in βTM patients.

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