Abstract
BackgroundThere are many conflicting opinions regarding the association between anemia and diabetes mellitus (DM), and the mechanism by which DM influences anemia remains uncertain. Therefore, we aimed to investigate the association between anemia and DM in Korean adults and to analyze the risk factors for anemia among these patients according to sex.MethodsThis retrospective cross-sectional survey was conducted using data from the Korea National Health and Nutrition Examination Survey V, VI, and VII between January 2010 and December 2016. In total, 25,597 Korean adults aged ≥19 years (10,117 men, 15,480 women) were included. Patients with a fasting blood sugar level of ≥126 mg/dL or who have been diagnosed with DM were classified as the DM group. Anemia was defined as hemoglobin levels of < 13 g/dL in men and < 12 g/dL in women. Logistic regression analysis was used to adjust for demographic characteristics and lifestyle-, disease-, and health-related factors.ResultsApproximately 11.3% of patients had DM. The prevalence of anemia was significantly higher in the DM group than in the non-DM group. After adjusting for confounding factors, the odds of the prevalence of anemia in men were higher in the DM group than in the non-DM group (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.42–2.50, p < 0.0001). When investigated according to the serum creatinine level, the association was significantly stronger among women (OR 42.63, 95% CI 17.25–105.36, p < 0.0001) than among men (OR 6.30, 95% CI 3.08–12.90, p < 0.0001).ConclusionsWe found a strong association between DM and anemia that was more prominent among men than among women. We also determined that the serum creatinine level had a greater influence on DM and anemia in women than in men.
Highlights
There are many conflicting opinions regarding the association between anemia and diabetes mellitus (DM), and the mechanism by which DM influences anemia remains uncertain
Model 1: unadjusted Model 2: adjusted for age, sex, household income, educational level, body mass index, smoking status, and alcohol consumption Model 3: adjusted for age, sex, household income, educational level, body mass index, smoking status, alcohol consumption, iron intake per day, serum creatinine level, high waist circumference, hypertension, hypertriglyceridemia, and low high-density lipoprotein cholesterol level a Odds ratios with adjustments using logistic regression models DM diabetes mellitus; OR odds ratio; CI confidence interval those in the non-DM group by 1.31-fold and 1.33-fold in Models 2 and 3, respectively
With regard to previous studies on DM and anemia, a study conducted among adults from the United States reported no association between DM and anemia, regardless of sex, which was in line with the conclusion drawn in a study from Spain that analyzed patients on nephrology dialysis reported no association between DM and anemia [14, 21]
Summary
There are many conflicting opinions regarding the association between anemia and diabetes mellitus (DM), and the mechanism by which DM influences anemia remains uncertain. The incidence of DM is increasing most rapidly among middle-to-low income countries [3], and it is predicted that one in 10 adults aged ≥20 years will have DM by 2045 [4]. Such a marked increase in the prevalence of DM could pose a significant economic burden on a country’s healthcare system. Cardiovascular disease is considered a major cause of premature death, and its incidence among patients with DM reaches 20% after approximately 7 years [7]. DM is often accompanied by acute or chronic complications, and because chronic complications are directly associated with patient death, prevention of such complications is of utmost importance
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