Diabetes mellitus and anemia are common in the elderly and adversely affect clinical outcomes, according to retrospective analysis of data published in the Journal of Diabetes Research.

The study from Poland evaluated 981 patients aged 60 years and older who attended primary care clinics between 2013 and 2014. The objectives of the study were to examine the frequency of the concomitant diabetes and anemia and also their clinical impact on the patients. Data was obtained from medical records of primary care clinics, specialist consultation cards, and patient discharge records.

Anemia was considered as hemoglobin less than 13 g/dL in men and less than 12 g/dL in women. The diagnosis of diabetes was based on random blood glucose level greater than 200 mg/dL together with the classical symptoms of diabetes such as polyuria, increased thirst or fasting blood glucose more than 126 g/dL on two occasions or blood glucose 200 mg/dL at 120 minutes after an oral glucose load of 75 g.

The prevalence of diabetes in the elderly patients in this study was 25% and 5.4% of patients had both anemia and diabetes. Unexplained anemia (32.1%), anemia of chronic diseases (28.3%) and iron deficiency anemia (18.9%) were the most common types of anemia in diabetic patients. Chemo- and/or radiotherapy-induced anemia and anemia due to vitamin B 12 and folate deficiency, hemorrhagic anemia, renal insufficiency were the other types of anemia in these patients. ESR was raised in the anemic diabetes patients indicating the inflammatory nature of anemia and diabetes.

Prevalence of comorbidities was higher in patients with both diabetes and anemia; they were hospitalized more often and were also at higher risk of death.

Macrovascular complications of diabetes are well-known. Anemia is also detrimental to cardiovascular health. Nearly 5% of patients, more men than women, had peripheral artery disease (PAD). Patients with both diabetes and anemia frequently underwent medical interventions such as coronary angiography, percutaneous coronary intervention, coronary artery bypass surgery, arteriography including procedures for chronic lower limb ischemia. Mortality at 3 years was higher in anemic patients with diabetes compared to diabetic patients who did not have anemia; 86.4% vs. 99.3%, respectively suggesting anemia as a risk factor for mortality in patients with diabetes.

This study has demonstrated that diabetes and anemia frequently coexist. Anemia not only had an unfavorable impact on clinical outcomes in these patients as evident by the frequent hospitalizations and interventions, it also adversely affected their survival. Hence, correction of anemia in patients with diabetes must be undertaken “as it may positively affect the course of diabetes as well as the prognosis”.  

Reference

1. Michalak SS, et al. Clinical implications of the coexistence of anemia and diabetes mellitus in the elderly population. Journal of Diabetes Research, vol. 2021, Article ID 8745968, 2021. https://doi.org/10.1155/2021/8745968.