The Frequency and Some Causes of Anemia in Patients with Diabetes Mellitus with Normal Renal Function

Öz

Introduction: Diabetes Mellitus (DM) is one of the most common chronic diseases worldwide according to World Health Organization reports. Anemia is common in patients with DM and anemia is a common hematological disorder in diabetic patients. In our study, we aimed to determine the anemia prevalence and the causes that affect anemia in patients with DM with normal renal function. Materials and Methods: Patients with DM who applied to Eskişehir Osmangazi University Medical Faculty Hospital (the clinics of Family Medicine and Internal Medicine) was included in our study and 229 patients with DM who were not diagnosed with renal dysfunction were included in our study within the last 6 months examinations. Laboratory results that were reviewed in the last 6 months were retrospectively screened and recorded. The hemoglobin (Hb) limit values were evaluated as 12 grams/deciliter (g/dl) in females and 13 g/dl in males and patients with Hb levels below these values were accepted as anemia. The data obtained at the end of the study were analyzed by using SPSS package program. Results: DM patients with normal renal function were included in the study. %25.8 (n=59) of patients had anemia. While 20.3% of the anemia was microcytic anemia, 79.7% was non-microcytic anemia (macrocytic and normocytic anemia). Iron deficiency was found in 57.1% (n = 32), while B12 deficiency was found in 11.8% (n = 7) and folic acid deficiency was found in 3.3% (n = 2) of patients with anemia. Iron deficiency was found in 9.9% (n = 14) of DM patients without anemia. Conclusion: Iron deficiency is the most diagnosed reason of anemia in DM patients. As the clinicians, we can provide early diagnosis and treatment of anemia in diabetic patients especially iron deficiency and we can improve the quality of life of patients and decrease morbidity and mortality.

Anahtar Kelimeler

• Anemia
• Diabetes mellitus
• diabetic complication

Böbrek Fonksiyonları Normal Olan Diyabetes Mellitus Hastalarında Anemi Sıklığı ve Bazı Nedenleri

Öz

Giriş: Diyabetes Mellitus Dünya Sağlık Örgütü raporlarına göre tüm dünyada en sık rastlanan kronik hastalıkların başında gelmektedir. Diyabetes Mellitus’u olan hastalarda anemi yaygındır ve anemi, diyabetik hastalarda sık görülen hematolojik bozukluklardandır. Çalışmamızla, böbrek fonksiyonları normal olan Diyabetes Mellitus hastalarında anemi sıklığını ve anemiyi etkileyen sebepleri belirlemeyi amaçladık. Materyal ve Metot: Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Hastanesi Aile Hekimliği ve İç Hastalıkları polikliniklerine başvuran DM hastaları çalışmamıza dahil edilmiş olup, son 6 ay içinde yapılan muayenelerinde ve tetkiklerinde böbrek fonksiyon bozukluğu saptanmayan 229 DM hastası çalışmamıza dahil edilmiştir. Son 6 ayda çalışılan laboratuvar sonuçları retrospektif olarak tarandı ve kaydedildi. Hemoglobin (Hb) sınır değerleri kadınlarda 12 gram / desilitre (g / dl), erkeklerde 13 g / dl olarak değerlendirildi ve bu değerlerin altında Hb seviyeleri olan hastalar anemi olarak kabul edildi. Çalışma sonunda elde edilen veriler SPSS paket programı kullanılarak analiz edilmiştir. Bulgular: Toplam 229 böbrek fonksiyonları normal olan DM hastası çalışmaya dahil edilmiştir. Anemilerin %20.3’ü mikrositer anemi iken, %79.7’si mikrositer olmayan anemiydi. Anemisi olan hastaların %57.1’inde (n=32) demir eksikliği saptanırken, %11.8’inde (n=7) B12 eksikliği, %3.3’ünde (n=2) folik asit eksikliği saptanmıştır. Anemi saptanmayan DM hastalarının da %9.9’unda (n=14) demir eksikliği olduğu belirlenmiştir. Sonuç: Demir eksikliği, DM hastalarında en sık teşhis edilen anemi nedenidir. Klinisyenler olarak, özellikle demir eksikliği olan diyabetik hastalarda erken dönemde anemi tanısı ve tedavisini sağlayabiliriz ve hastaların yaşam kalitesini iyileştirebilir, morbidite ve mortaliteyi azaltabiliriz.

Anahtar Kelimeler

• Anemi
• Diabetes mellitus
• diabetik komplikasyon

Kaynakça

1. 1. Olgun N, Yalın H, Gülyüz Demir H. Diagnosis And Risk Determination Of Diabetes Dealing With Diabetes. Turkish Family Physcian, 2011; 2(2): 36-44.
2. 2. Gücük S, Boztas G. The Effects of Family Medicine Practice on Diabetic Patients’ Follow up. Konuralp Medical Journal 2013; 5(2):12-16.
3. 3. Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev.2013; 93: 137–188.
4. 4. Sezgin H, Çınar S. Follow-up of Patients with Type 2 Diabetes Via Cell Phone: Randomized Controlled Trial. Journal of Marmara University Institute of Health Sciences 2013;3(4):173-183.
5. 5. Chung JO, Park SY, Cho DH, Chung DJ, Chung MY. Anemia, bilirubin, and cardiovascular autonomic neuropathy in patients with type 2 diabetes. Medicine (Baltimore), 2017; 96(15): 6586.
6. 6. Thomas MC, MacIsaac RJ, Tsalamandris C, Molyneaux L, Goubina I, Fulcher G, et al. The burden of anaemia in type 2 diabetes and the role of nephropathy. A cross-sectional audit. Nephrol Dial Transplant. 2004;19:1792–7.
7. 7. White KE, Bilous RW. Type 2 diabetic patients with nephropathy Show structural - functional relationships that are similar to type 1 disease. J Am Soc Nephrol.2000; 11: 1667 - 1673.
8. 8. Thomas MC. Anemia in diabetes: marker or mediator of microvascular disease? Nat Clin Pract Nephrol. 2007;3:20–30.

9. 9. A case–control study of prevalence of anemia among patients with type 2 diabetes. Antwi-Bafour et al. Journal of Medical Case Reports. 2016; 10:110.
10. 10. Sahay M, Kalra S, Badani R, Bantwal G, Bhoraskar A, Das AK, Dhorepatil B, et al. Diabetes and Anemia: International Diabetes Federation (IDF)–Southeast Asian Region (SEAR) position statement. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2017; 11: 685-695.
11. 11. Sahay M, Kalra S, Badani R, Bantwal G, Bhoraskar A, Das AK, Dhorepatil B, et al. Diabetes Metab Syndr. 2017 Dec;11 (2): 685-95.
12. 12. Chiu WC, Lai YR, Cheng BC, Huang CC, Chen JF, Lu CH. HbA1C Variability Is Strongly Associated with Development of Macroalbuminuria in Normal or Microalbuminuria in Patients with Type 2 Diabetes Mellitus: A Six-Year Follow-Up Study. Biomed Res Int. 2020; 2020:7462158.
13. 13. Summerville DA, Clinton SP, Treves ST. The use of radiopharmaceuticals in the measurement of glomerular filtration rate: A review. In: Freeman LM ed. Nuclear Medicine Annual. New York: RavenPress;1990:191-221
14. 14. Melk A, Ramassar V, Helms LM, et al. Telomere shortening in kidneys with age. J Am Soc Nephrol 2000;11(3): 444-53.
15. 15. Türk Hematoloji Derneği. Yetişkinde Demir Eksikliği Tanı Ve Tedavi Kılavuzu. Ulusal Tedavi Kılavuzu. 2011; 23-24. http://www.thd.org.tr/thdData/Books/94/bolum-iii-yetiskinde-demir-eksikligi-tani-ve-tedavi-kilavuzu.pdf Son Erişim Tarihi: 18/06/2019.
16. 16. Glader B. Anemias, In: Behrman R, Kliegman R, Jenson H. eds. Nelson Textbook of Pediatrics. 17th ed. Pennsylvania: Saunders, 2004: 1604-6.
17. 17. Jose Antonio Moreno Chulilla, Maria Soledad Romero Colás, Martín Gutiérrez Martín. Classification of anemia for gastroenterologists. World J Gastroenterol 2009; 15: 4627-37.
18. 18. Honzik T, Adamovicova M, Smolka V, Magner M, Hruba E, Zeman J. Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B(12) defi ciency. What have we learned? Eur J Paediatr Neurol. 2010; 14: 488-95.
19. 19. Koc A, Kocyigit A, Soran M, Demir N, Sevinc E, Erel O et al. High frequency of maternal vitamin B12 defi ciency as an important cause of infantile vitamin B12 defi ciency in Sanliurfa province of Turkey. Eur J Nutr 2006; 45: 291-7.
20. 20. He BB, Xu M, Wei L, Gu YJ, Han JF, Liu YX, Bao YQ, Jia WP. Relationship between Anemia and Chronic Complications in Chinese Patients with Type 2 Diabetes Mellitus. Arch Iran Med. 2015;18(5):277-83.
21. 21. Leifert JA. Anaemia and cigarette smoking. Int J Lab Hematol. 2008;30(3):177-84.
22. 22. Calvo Romero JM, Ramiro Lozano JM. Vitamin B(12) in type 2 diabetic patients treated with metformin. Endocrinol Nutr. 2012;59:487–90.
23. 23. Nervo M, Lubini A, Raimundo FV, Faulhaber GA, Leite C, Fischer LM, et al. Vitamin B12 in metformin-treated diabetic patients: A cross-sectional study in Brazil. Rev Assoc Med Bras. 2011;57:46–9.
24. 24. Raizada N, Jyotsna VP, Sreenivas V, Tandon N. Serum Vitamin B12 Levels in Type 2 Diabetes Patients on Metformin Compared to those Never on Metformin: A Cross-sectional Study. Indian J Endocrinol Metab. 2017;21(3):424-428.
25. 25. McGill JB, Bell DSH. Diyabette anemi ve eritropoetinin rolü. Journal of Diabetes and its Complition. 2006; 2(4): 200-212.