Pancreatic iron is common in transfused sickle cell disease(SCD) patients but the functional significance is unknown. We compared pancreatic function with hepatic and pancreatic iron burden by MRI in 28 SCD patients. Six patients had impaired fasting glucose(IFG) values and one had impaired glucose tolerance. Insulin resistance was positively associated with body mass index and negatively associated with liver iron concentration (r2 = 0.50, p<0.004). Liver iron and serum ferritin predicted IFG with an AUROC of 0.82 and 0.86 respectively. Beta cell function was inversely proportional to pancreatic R2* (r2 = 0.17, p=0.01). Thus, prediabetic changes were common and related to liver and pancreatic iron.