Anaemia a marker of mortality in type 2 diabetes

Experts from Western Australia are recommending that people with type 2 diabetes are regularly screened for iron deficiency after findings from their study linked anaemia with a higher risk of mortality.

The analysis of almost 2,000 participants in the Fremantle Diabetes Study Phase ll and the Busselton Diabetes Study revealed adults with type 2 diabetes had a 28.7% mortality rate compared to 8% for people who did not have anaemia.

The authors say the findings reinforce the importance of screening for and addressing any modifiable risk factors for anaemia along with optimal diabetes management.

Co-author Professor Tim Davis, from the University of Western Australia, said anaemia as a complication of diabetes appeared to be a surrogate for long-term glucose exposure of tissues such as the kidney.

“The association with mortality is a reminder of what happens if diabetes is not looked after. The bone marrow and the kidney get badly affected by long term glucose exposure.”

The data highlighted anaemia rates of 11.5% and 17.8% respectively in people with diabetes, compared to 5.4% in a control group.

The risk of anaemia increased 5% for every year of diabetes duration however there were also a number of potentially reversible risk factors.

“The data suggests screening for vitamin B12, iron and perhaps magnesium would be sensible and initiating replacement therapy in patients found to be deficient,” Professor Davis said.

“Beyond that, do all you can to preserve renal function via glycaemic control and blood pressure control.”

The study found an eGFR <60ml/min/1.73m2 was the strongest determinant of anaemia.

“Even a mild degree of renal impairment (eGFR 60-89 mL/min/1.73m2) almost doubled the risk of anaemia compared to normal renal function,” the study said.

Metformin and glitazone therapy also almost doubled the risk of anaemia – with metformin known to reduce serum vitamin B12 levels and glitazones resulting in fluid retention and haemodilution.

The study concluded that people with type 2 diabetes should have periodic haemoglobin checks and follow up tests to determine the underlying cause of any anaemia including serum vitamin B12, iron, magnesium, testosterone and haemoglobin electrophoresis for haemoglobinopathies.

Professor Davis said patients with a short duration of diabetes and anaemia that could not be explained by other factors should also be investigated for malignancy.

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