Anemia in Patients with Type 1 Diabetes

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Abstract
Anemia is a common finding in diabetes, although most pa- tients in these studies have type 2 disease. This study exam- ines the prevalence and predictors of anemia in outpatients with type 1 diabetes. A full blood count was obtained in ad- dition to routine testing in patients with type 1 diabetes at the Austin Medical Centre (n 135), Melbourne, the Royal Prince Alfred Hospital (n 42), and the Royal North Shore Hospital (n 135), both in Sydney, Australia. One in seven patients had anemia (14%). Patients at great- est risk could be identified by the presence of diabetic kidney disease. More than half (52%) of patients with macroalbumin- uria had anemia, compared with 24% of patients with mi- croalbuminuria and less than 8% of normoalbuminuric pa- tients. Patients with diabetes and renal impairment were more than six times more likely to have anemia than those with normal renal function. Patients with anemia were more likely to have retinopathy and macrovascular complications than were patients with a normal hemoglobin level, indepen- dent of comorbid renal disease. Anemia is a prevalent finding in patients with type 1 dia- betes and represents a significant unrecognized burden. Pa- tients at greatest risk can be identified by the presence of renal disease, in the form of albuminuria and/or renal impairment. (J Clin Endocrinol Metab 89: 4359 - 4363, 2004) I T HAS BEEN recently recognized that anemia is a common complication of diabetes, particularly in patients with diabetic kidney disease. In a recent cross-sectional survey of patients with diabetes in a single clinic, we found that nearly a quarter of all outpatients had anemia (1). Anemia develops earlier than in patients with renal impairment from other causes (1- 4). In addition, a normochromic, normocytic ane- mia can also be observed in patients without overt renal disease (4). It is now established that reduced hemoglobin (Hb) levels, even to a limited degree, identify patients at increased risk of progressive renal disease (5, 6). However, the majority of patients in these studies had type 2 diabetes. As a consequence, anemia associated with ageing and/or renal impairment may be overrepresented in these popula- tions. Against this, patients with type 2 diabetes may have a slower rate of progression of diabetic renal disease, and the cumulative incidence of nephropathy may be less than in patients with type 1 diabetes. The consequences of these difference on the prevalence and predictors of anemia in type 1 diabetes have not been established. As a follow-up to our initial study (1), we present a composite survey from three clinical centers to estimate the burden of anemia in outpa- tients with type 1 diabetes.

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