The Relation between Anemia and Microvascular Complications in Patients with Type 2 Diabetes Mellitus

Abstract
Background: Recently, it has been demonstrated that anemia may be an etiological factor in development of micro-vascular complication in type 2 D.M. patients.
Objective: Evaluation of the relation between anemia and microvascular complications in patients with type 2 diabetes mellitus.
Methods: 100 patients were included in the study. They were selected from wards of Internal Medicine Department and Outpatient Endocrinology Clinic in Tanta University Hospital during the period from February 2016 to August 2016. They divided into two groups, Group (I): 50 patients DM type 2 without anemia. Group (II): 50 patients DM type 2 with anemia (Hb level >10gm/dl). Inclusion criteria: Patients diagnosed to have type 2DM, anemia with (Hb level >10gm/dl) in Group (II). Exclusion criteria: Type 1 DM or other types of diabetes, patients with obvious cause of anemia e.g. hemo-lytic anemia, aplastic anemia, acute blood loss, severe infection, collagen disease. Chronic illness e.g. severely impaired liver functions (AST or ALT more than 2 upper limit of normal), end stage renal disease. All patients were subjected to: History taking after providing a written informed consent. Full clinical examination including; anthropometric parameters {weight, height, Body Mass Index (BMI)}. Upon recruitment, all patients underwent comprehensive assessment of diabetes-related microvascular complications as following: Diabetic Retinopathy (DR) was assessed by professional ophthalmol-ogists, diabetic nephropathy was assessed according to 24hr albumin collection in urine. Diabetic peripheral neuropathy was diagnosed by: The presence of typical symptoms and compatible finding from neurological examination or. History of treatment for neuropathy. Laboratory investigations includ-ing: Fasting and 2 hour post prandial blood glucose. HbA1C, complete blood count, blood urea, serum creatinine and estimated glomerular filtration rate. 24 hour collection of urine albumin liver function tests. Erythrocyte Sedimentation rate (ESR). C Reactive Protein (CRP) complete iron profile and abdomino-pelvic ultrasound.
Results: Comparison between the 2 studied groups showed that 24% of Group I (DM without anemia) had neuropat hy while 100% of Group II (DM with anemia) had neuropathy with statistical significance (p-value <0.001). Also comparison between the 2 studied groups showed that 26% of Group I had retinopathy while 100% of Group II had retinopathy with statistical significance (p-value <0.001). The mean of 24hr ALB which represent diabetic nephropathy in Group I was (25.10±4.10mg/24hr) while the mean of it in Group II was (349.26±87.67mg/24hr). The mean 24hr ALB in Group II was higher than Group I with statistical significance (p-value <0.001).
Conclusion: Our finding suggests that microvascular complications (diabetic neuropathy, diabetic nephropathy and diabetic retinopathy) were common with anemic patients than the non anemic patients. So we can conclude that anemia may be an etiological factor in development of microvascular complication in type 2 D.M. patients.