Study of anemia in diabetes and its association with 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.