Testosterone deficiency is common in men with diabetes, regardless of the type. Testosterone levels are partly influenced by insulin resistance, which may represent an important avenue for intervention, whereas the utility of testosterone replacement remains to be established in prospective trials.

OBJECTIVE -Anemia is common in diabetes, potentially contributing to the pathogenesis of diabetes complications. This study aims to establish the prevalence and independent predictors of anemia in a cross-sectional survey of 820 patients with diabetes in long-term follow-up in a single clinic. RESEARCH DESIGN AND METHODS-A full blood count was obtained in addition to routine blood and urine test results for all patients over a 2-year period to encompass all patterns of review. Predictors of the most recent Hb concentration and anemia were identified using multiple and logistic regression analysis.RESULTS -A total of 190 patients (23%) had unrecognized anemia (Hb Ͻ12 g/dl for women and Ͻ13 g/dl for men). This prevalence is two to three times higher than for patients with comparable renal impairment and iron stores in the general population. Independent predictors for Hb were transferrin saturation, glomerular filtration rate (GFR), sex, albumin excretion rate, and HbA 1c level (all P Ͻ 0.0001). Microalbuminuric patients were Ͼ2 times (odds ratio [OR] 2.3) and macroalbuminuric patients Ͼ10 times (OR 10.1) as likely to have anemia than normoalbuminuric patients with preserved renal function (GFR Ͼ80 ml/min).CONCLUSIONS -Anemia is a common accompaniment to diabetes, particularly in those with albuminuria or reduced renal function. Additional factors present in diabetes may contribute to the development of increased risk for anemia in patients with diabetes. Diabetes Care 26:1164 -1169, 2003D iabetes is the single most common cause of end-stage renal disease (1) and therefore the most common cause of renal anemia. In addition, anemia may be more common in diabetes (2) and develop earlier than in patients with renal impairment from other causes (3). The predominance of damage to renal interstitium, systemic inflammation, and autonomic neuropathy have all been suggested as contributors to anemia in diabetic nephropathy (DN) (3). Like many pathophysiological changes of DN, dysfunction may be apparent before demonstrable changes in the glomerular filtration rate (GFR).It is unproven whether anemia directly contributes to the acceleration of complications in DN or to the progression of diabetic renal disease. However, patients with diabetes may be more vulnerable to the effects of anemia because many also have significant cardiovascular disease and hypoxia-induced organ damage. In addition, a number of studies (4 -6) have suggested that Hb levels may be linked to the risk of cardiovascular events, hospitalization, and mortality. Against this, there is no conclusive evidence that correcting anemia significantly improves outcomes in patients with failing renal function, apart from quality of life (7).Because most patients with DN have little overt renal impairment, the majority are supervised by their primary care physician or endocrinologist. However, significant pathology may be present in patients with DN before meeting criteria for referral to a nephrologist (GFR ϳ30 ml/min) (8). In this population, renal anemia may g...

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