A case–control study of prevalence of anemia among patients with type 2 diabetes

Abstract

BackgroundAnemia is defined as a reduction in the hemoglobin concentration of blood, which consequently reduces the oxygen-carrying capacity of red blood cells such that they are unable to meet the body’s physiological needs. Several reports have indicated that anemia mostly occurs in patients with diabetes with renal insufficiency while limited studies have reported the incidence of anemia in people with diabetes prior to evidence of renal impairment. Other studies have also identified anemia as a risk factor for the need for renal replacement therapy in diabetes. Understanding the pathogenesis of anemia associated with diabetes may lead to the development of interventions to optimize outcomes in these patients. The aim of this study was therefore to determine the prevalence of anemia among patients with type 2 diabetes.MethodsA total of 100 (50 with type 2 diabetes and 50 controls) participants were recruited for our study. Participants’ blood samples were analyzed for fasting blood glucose, full blood count and renal function tests among others. The prevalence of anemia was then determined statistically.ResultsA high incidence of anemia was observed in the cases. Of the patients with diabetes, 84.8 % had a hemoglobin concentration that was significantly less (males 11.16±1.83 and females 10.41±1.49) than the controls (males 14.25±1.78 and females 12.53±1.14). Renal insufficiency determined by serum creatinine level of >1.5 mg/dL, estimated glomerular filtration rate <60 ml/minute/1.73 m2, and erythropoietin levels was also observed to be high in the cases (54.0 %; with mean creatinine concentration of 3.43±1.73 and erythropoietin 6.35±1.28 mIU/mL). A significantly increased fasting blood glucose, urea, sodium, potassium, and calcium ions were observed in the cases (7.99±1.30, 5.19±1.99, 140.90±6.98, 4.86±0.53 and 1.47±0.31 respectively) as compared to the controls (4.66±0.54, 3.56±2.11, 135.51±6.84, 4.40±0.58 and 1.28±0.26 respectively). Finally, a significant association between hemoglobin concentration and fasting blood glucose was also observed in the cases.ConclusionsThe findings suggest that a high incidence of anemia is likely to occur in patients with poorly controlled diabetes and in patients with diabetes and renal insufficiency.

<p>Anemia and Its Associated Factors Among Type 2 Diabetes Mellitus Patients Attending Debre Berhan Referral Hospital, North-East Ethiopia: A Cross-Sectional Study</p>

“…55,[60][61][62] In addition, normocytic normochromic anemia might suggest the significance of the renal origin of anemia in diabetic patients. 6,7,63,64 Considering the percentage of anemic patients with altered renal function in this study, the above explanation seems acceptable. Renal impairment leads to anemia though impaired production of erythropoietin by peritubular fibroblast of the kidney, [65][66][67] urinary erythropoietin losses, 68 reduced RBC life span due to uremic environment and the possible role of circulating uremic-induced prevention of erythropoiesis.…”

“…32 These differences might be due to differences in the geographical elevation above sea level, ethnicity, age of the study participants, duration of DM, and the level of development of the country since it affects the quality of health care delivery. 6,8,33,43,56 The study tried to demonstrate the common morphological characteristics of anemia among T2DM patients. Normocytic normochromic blood picture was the most common morphological types of anemia found in this study.…”

“…Diabetes-related chronic hyperglycemia can cause a chronic hypoxic milieu in the renal interstitium and disturbance of the interstitial organization or vascular architecture, atypical cell growth and collagen proliferation in tubular cells and peritubular fibroblasts, which cause impaired synthesis of erythropoietin by the peritubular fibroblasts. 6,20 In addition, in patients with prolonged hyperglycemic conditions, the erythrocyte precursors cells in the bone marrow might be exposed to prolonged direct glucose toxicity leading to disturbances in the erythrocyte production. 35 This study indicated that the odds of developing anemia among respondents with poor glycemic control were three times more likely as compared with respondents with good glycemic control.…”

“…5 The chronic hyperglycemia of diabetes, especially when poorly controlled, causes long-term damage, dysfunction, and failure of different organs of the body like the eyes, kidneys, nerves, blood, and blood vessels. 6 Anemia is one of the commonest and prevalent blood-related disorder occurs in patients with diabetes. 7 It mostly occurs in DM patients who also have renal impairment.…”

“…15 Diabetic neuropathy, chronic inflammatory activity, increased levels of advanced glycation end products (AGEs), erythropoietin hypo-responsiveness, effects of oxidative stress, and anti-diabetic medications are other possible cause of anemia in DM patients. 6,[16][17][18][19][20] Results from many studies showed in the diabetic clinics, the prevalence of unrecognized anemia is nearly two to three folds greater than the general population. In addition, DM patients tend to develop anemia at earlier ages and with greater severity than the general population, putting these patients at greater risk of complications, and this additional burden greatly contributes to patient's comorbid vascular disease and adverse outcomes.…”