Background: Chronically transfused patients such as sickle cell disease (SCD) and beta thalassemia major (TM) develop iron overload. Objective: Determine the significance of pancreatic iron in SCD. Methods: Prospective study of 28 SCD and 40 TM patients who underwent research MRIs with liver and pancreas R2*. Patients with normal fasting glucose underwent oral glucose tolerance test. Results: Impaired fasting glucose (2 vs 9, p=0.27) and impaired glucose tolerance (1 vs 11, p=0.019) were less common in SCD compared with TM patients. No SCD patient had diabetes. Conclusion: 22% had significant pancreatic iron, with 1/3 of those having impaired fasting glucose.