Health care providers out there may have noticed that anemia is a not-infrequent finding amongst patients with type 2 diabetes.

It turns out that there are multiple reasons for anemia in type 2 diabetes – and the health consequences may be severe.

A study was recently published evaluating the prevalence, risk factors, and prognosis of anemia in two groups of Australian patients.  They found that the prevalence of anemia was double to triple in people with type 2 diabetes, compared to people without diabetes.

They found multiple risk factors independently associated with a higher risk of anemia, including:

  • impaired kidney function: related at least in part to reduced erythropoeitin production by the kidneys, which is a hormone that stimulates red blood cell production
  • longer duration of diabetes: 5% increased risk of anemia per year of having diabetes – may be due to decreased red blood cell production and/or increased destruction, as consequences of chronically elevated blood sugar
  • metformin use: likely related to vitamin B12 deficiency, but other mechanisms such as low magnesium are considered
  • thiazolidinedione use [pioglitazone (Actos) or rosiglitazone (Avandia)]: likely related to fluid retention
  • peripheral arterial disease: possibly related to higher oxidative stress, inflammation, atherosclerosis
Other risk factors were identified as well, such as low iron, and low testosterone in men.
After adjustment for other independent predictors of mortality, anemia was associated with a 57% increased risk of mortality over the mean of 4.3 years of study, compared to people with diabetes but without anemia.
The good news is that many of these risk factors for anemia are treatable, and even preventable.  For example: optimizing blood sugar control; checking vitamin B12 in people on metformin; checking iron levels in people who are anemic and investigating for the cause of low iron if so. 

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