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Diabetes doubles risk for anemia
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Adults with type 2 diabetes are twice as likely to develop anemia as those without the disease, but most patients with diabetes who developed anemia had one or more recognized risk factors that were treatable, according to an analysis of community-based cohorts in Australia.
“Anemia has been considered a frequent and unrecognized comorbidity in diabetes, but estimates of its prevalence vary widely,” Richard Gauci, MBBS, FRACP, an endocrinologist and nuclear medicine physician at Fiona Stanley Hospital in Western Australia, and colleagues wrote in the study background. “Whatever the cause, the consequences of anemia complicating diabetes appear adverse, including evidence of increased all-cause and cardiovascular mortality.”
Gauci and colleagues analyzed data from patients with type 2 diabetes from two population-based, observational studies — the Fremantle Diabetes Study Phase II (FDS2; n = 1,551; mean age, 66 years; 51.9% men) and the Busselton Diabetes Study (BDS; n = 186; mean age, 70 years; 50% men) — as well as from 186 matched BDS participants without diabetes. Participants for both studies were recruited between 2008 and 2011. Participants were assessed at baseline and invited to biennial reviews over 6 years, with questionnaire follow-up in alternate years.
Researchers assessed the prevalence of anemia, defined as a hemoglobin of 130 g/L or less in men and 120 g/L or less in women, in each sample. In the FDS2 study, researchers used multiple logistic regression and Cox proportional hazards models to identify associates of anemia (including renal impairment, diabetes duration, blood pressure and mean erythrocytic cellular volume) as predictors of death during a mean of 4.3 years.
In the FDS2 and BDS cohorts, one in six and one in nine patients with type 2 diabetes had anemia, respectively, revealing that diabetes doubled or tripled the risk for anemia compared with prevalence in the general population, the researchers noted.
Across groups, 11.5% of FDS2 participants had anemia, as did 17.8% of BDS patients with type 2 diabetes and 5.4% of BDS patients without diabetes. In the FDS2 cohort, 91.6% of patients with anemia had at least one other risk factor. Risk factors included serum vitamin B12 level 140 pmol/L or less, serum ferritin 30 g/L or less and/or transferrin saturation of 20% or less, serum testosterone 10 nmol/L or less, glitazone therapy, an estimated glomerular filtration rate less than 60 mL/min/1.73 m², malignancy or hemoglobinopathy. More anemic than non-anemic patients from the FDS2 cohort died (28.7% vs. 8%; P < .001).
After adjustment for other independent predictors, such as age as time-scale, male sex, Aboriginal heritage, marital status, smoking status and eGFR, anemia was associated with a 57% increase in mortality (P = .015), according to the researchers.
“Based on the present data, we recommend periodic (eg, yearly) hemoglobin measurement as part of regular assessment of patients with type 2 diabetes wherever they are managed,” the researchers wrote. “In those who are anemic by WHO definitions, serum iron and vitamin B12 status should be established and deficiencies treated.”
The researchers noted that other laboratory tests such as serum magnesium, serum testosterone and hemoglobin electrophoresis may be appropriate and prompt intervention, depending on patient characteristics and clinical context. In those patients with short duration diabetes and no clear risk factors, the possibility of underlying malignancy should be considered, they wrote.
“Given the relationship with subsequent mortality, we also recommend that management of anemic patients with type 2 diabetes should include increased efforts to optimize glycemic control and non-glycemic [CV] risk factors,” the researchers wrote. – by Regina Schaffer
Disclosure: the researchers report no relevant financial disclosures.
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