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Unrecognized Anemia in Patients With Diabetes

A cross-sectional survey

¹ Department of Medicine, Austin and Repatriation Medical Center, Heidelberg, Victoria, Australia
² Department of Endocrinology, Austin and Repatriation Medical Center, Heidelberg, Victoria, Australia
³ Department of Nephrology, Austin and Repatriation Medical Center, Heidelberg, Victoria, Australia

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 <12 g/dl for women and <13 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 < 0.0001). Microalbuminuric patients were >2 times (odds ratio [OR] 2.3) and macroalbuminuric patients >10 times (OR 10.1) as likely to have anemia than normoalbuminuric patients with preserved renal function (GFR >80 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.

Abbreviations: AER, albumin excretion rate • ARMC, Austin and Repatriation Medical Center • DN, diabetic nephropathy • GFR, glomerular filtration rate • NHANES III, Third National Health and Nutrition Examination Survey • TSAT, transferrin saturation • WHO, World Health Organization

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