Anemia and Microvascular Complications in Patients With Type 2 Diabetes Mellitus

Abstract

Background:Although chronic kidney disease-induced anemia is more prevalent in patients with diabetes mellitus (DM), anemia is a common finding prior to manifestation of kidney disease. In presence of some risk factors at the time of diagnosing DM, microvascular complications must be considered. The effect of anemia as a risk factor on progression of DM complications is still unclear.Objectives:The aim of the study was to determine the prevalence of anemia and its association with microvascular complications in patients with type 2 DM.Patients and Methods:This cross-sectional study was performed in the outpatient endocrinology clinic at Baqiyatallah University of Medical Sciences Hospital, Tehran, Iran. Study was done from February 2011 to February 2012. Patients with type 2 DM without any obvious symptom or sign of anemia were included in study.Results:A total of 93 patients (30.4%) had anemia including 46 (15.1%) with normochromic normocytic, 44 (14.4%) with hyperchromic microcytic, and 3 (1%) with hyperchromic macrocytic anemias. There was a positive correlation between duration of DM and anemia. Microvascular complications were more frequent with normocytic or microcytic anemias. Glomerular filtration rate (GFR) was higher in patients without anemia; moreover, nephropathy was less frequent among them. Among patients with anemia, 43% had GFR of more than 90 mL/min and 19.4% had normoalbuminuria. Neuropathy, nephropathy, and retinopathy had strong association with anemia (odds ratio of 1.99, 1.7, and 1.5, respectively).Conclusions:Anemia is a common complication of DM and is associated with duration of disease and microvascular complications.

Anemia complicating type 2 diabetes: Prevalence, risk factors and prognosis

“…In the Predialysis Survey on Anemia Management (PRESAM) involving patients with advanced nephropathy, 2 diabetes did not increase the risk of anemia, but other studies from a variety of countries have shown that between 14% and 45% of patients with diabetes are anemic. [3][4][5][6][7][8] Notwithstanding the PRESAM data, this discrepancy may reflect differences in the proportions with renal impairment since the prevalence in outpatients with normal renal function (estimated glomerular filtration rate (eGFR) N 60 mL/min/ 1.73 m 2 ) has been estimated at only 10%. 9 An apparent diabetes-specific risk of anemia has been attributed to reduced responsiveness to erythropoietin (EPO).…”

Is HbA1c the only choice? Alternative biomarkers for glycaemic control assessment

“…Conversely, falsely decreased results are obtained from patients treated with iron preparations, vitamin B 12 , folic acid, erythropoietin, vitamins C and E. Similar effects are reported in conditions with shortened erythrocyte lifespan -i.a massive blood loss, hemolytic anemias -and hemoglobinopathies, splenomegaly, chronic liver diseases, in chronic alcohol drinkers, patients with hypertriglyceridemia, rheumatoid arthritis and retroviral therapy subjects [11][12][13][14][15][16].…”

“…Falsely elevated HbA 1c values are also observed in patients with vitamin B 12 , folic acid and iron deficiency anemiae, in chronic kidney disease, hyperbilirubinemia, in patients using acetylsalicylic acid in large doses, opiate users, post splenectomy patients and those with abnormal erythrocyte structure (lower than usual erythrocyte pH, longer erythrocyte lifespan) [11][12][13][14][15][16]. Conversely, falsely decreased results are obtained from patients treated with iron preparations, vitamin B 12 , folic acid, erythropoietin, vitamins C and E. Similar effects are reported in conditions with shortened erythrocyte lifespan -i.a massive blood loss, hemolytic anemias -and hemoglobinopathies, splenomegaly, chronic liver diseases, in chronic alcohol drinkers, patients with hypertriglyceridemia, rheumatoid arthritis and retroviral therapy subjects [11][12][13][14][15][16].…”

Impact of Iron Deficiency Anemia on Glycated Hemoglobin (HbA1c) Levels in Diabetics with Controlled Plasma Glucose Levels

“…[10][11][12] Prevalence of anemia is estimated about 10-30% in patients with diabetes. [13] The etiology of anemia in diabetics is multi-factorial and includes inflammation, nutritional deficiency, concomitant autoimmune diseases, drugs, hormonal changes in addition to kidney disease. Approximately one-third of patients with anemia exhibit iron deficiency.…”