Study of anemia in diabetes and its association with diabetic retinopathy

Authors

  • Archana Kansal Department of Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
  • Mahendra Chouhan Department of Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
  • Neelima Singh Department of Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
  • Sushma Trikha Department of Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
  • Jijo Verghese Department of Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20174299

Keywords:

Anemia, Diabetes mellitus, Diabetic retinopathy

Abstract

Background: Anemia is an increasingly recognized entity in patients with diabetes mellitus. Reduced hemoglobin levels identify diabetic patients with an increased risk of microvascular complications.

Methods: A hospital based observational prospective study was conducted in Department of medicine, J.A. Group of Hospitals, Gwalior from June 2014 to October 2015. Adults with diabetes mellitus both type 1 and type 2 were selected as subjects are included and anemia due to blood loss and anemia due to chronic kidney diseases were excluded from the study. Estimation of hemoglobin was done by using capillary method by calorimetric hemoglobinometer. Anemia was defined as hemoglobin <13 g/dl in men and <12 g/ dl in women. All the patients were examined for diabetic retinopathy and graded as none, mild, moderate, severe and proliferative retinopathy as per International clinical diabetic retinopathy disease severity scale.

Results: 100 patients were enrolled as subjects. Most of the patients 26 (26%) were in the age group 46-55 years. There were 53 males and 47 females. 42%, 45% and 13% had diabetes of <5 years, 5-10 years and > 10 years duration respectively. HbA1c levels were <7.5 in 74 (74%), 7.5-10 in 23 (23%) patients and > 10 in 3 (3%) patients. Overall 67 (67%) diabetics had anemia. Out of 53 males 30 (56.6%) had anemia and amongst females, out of 47 cases 37 (78.72%) had anemia P value 0.009. Anemia was more common in patients less than 50 years 36 (70.59%) compared to31 (63.2%) with anemia in patients more than 50 years. 65 (65%) patients had diabetic retinopathy (DR). 30 (46.1%) males and 35 (53.8%) females had diabetic retinopathy. All patients with diabetic retinopathy had anemia. Among 35 (35%) patients without DR only 2 (5.71%) had anemia. P value <0.001.

Conclusions: Anemia is a common accompaniment to diabetes. Anemia was more common in females and in those less than 50 years. Anemia was frequently associated with diabetic retinopathy. The high prevalence of anaemia supports regular screening for anemia, alongside that for other diabetes-related complications. This might help to delay the progression of vascular complications in these patients.

 

References

Salman MA. Anemia in patients with diabetes mellitus: prevalence and progression. Gen Med. 2015;3:162.

Andrews M, Arredondo M. Ferritin levels and hepcidin mRNA expression in peripheral mononuclear cells from anemic type 2 diabetic patients. Biol Trace Element Res. 2012;149:1-4.

Thomas MC. Anemia in diabetes: marker or mediator of microvascular disease? Nature Reviews Nephrol. 2007;3:20-30.

Aouacheri O, Saka S, Krim M, Messaadia A, Maidi I. The investigation of the oxidative stress-related parameters in type 2 diabetes mellitus. Can J Diabetes. 2015;39(1):44-9.

Thomas MC, Tsalamandris C, MacIsaac RJ, Jerums G. The epidemiology of hemoglobin levels in patients with type 2 diabetes. Am J Kidney Dis. 2006;48(4):537-45.

Ahmed AT, Go AS, Warton EM, Parker MM, Karter AJ. Ethnic differences in anemia among patients with diabetes mellitus: The Diabetes Study of Northern California. Am J Hematol. 2010;85(1):57-61.

Bahar A, Kashi Z, Amiri AA, Nabipour M. Association between diabetic retinopathy and hemoglobin level. Caspian J Intern Med. 2013;4:759-62.

Ito H, Takeuchi Y, Ishida H, Otawa A, Shibayama A, Antoku S, et al. Mild anemia is frequent and associated with micro‐ and macroangiopathies in patients with type 2 diabetes mellitus. J Diabetes Investig. 2010;1(6):273-8.

Thomas MC. Anemia in diabetes: marker or mediator of microvascular disease? Nature Reviews Nephrol. 2007;3:20-30.

Hooda A, Kim S, Kanna B. Target level of hemoglobin correction in patients with diabetes and CKD: primary results of the anemia correction in Diabetes (ACORD) study. Am J Kidney Dis. 2007;50:687-8.

Downloads

Published

2017-09-22

Issue

Section

Original Research Articles