Anemia and Much Older Type 2 Diabetes Patients

Anemia is higher in older type 2 diabetes patients…

The chances of an anemia diagnosis increase with age and it affects roughly about 10% of those 65 years of age or older. In diabetes patients, the probability of diagnosing anemia could be two to threefold higher and furthermore, from previous studies, anemia has been shown to have a direct relationship with renal insufficiency.

There are many factors that can lead to increasing the probability of getting anemia including decreasing renal function, inflammation, bone marrow suppression, and nutritional deficiencies. In this study, the researchers examined the prevalence and determinants of anemia among people age 85 years or older with a long duration of diabetes.

A total of 115 patients, average age 83.6 years old with 51% older than 85 years of age, were recruited for this study. About 50% of patients were male and ethnicity was 108 White, 5 Asian, and 2 Black. Anemia was prevalent in 59% of the older patients (>75 years of age) diagnosed as diabetes outpatients. The 80% of anemia was normocytic; anemia was microcytic in 17%, and macrocytic in 3% of patients. Patients with anemia were significantly older (84.6 vs. 82.1 years, P = 0.01), had a longer duration of diabetes (17.7 vs. 13.5 years, P = 0.03), and had lower eGFRs (47.8 vs. 58.1ml/min/1.73 m2, P = 0.01) than patients without anemia.

In the univariate logistic regression analysis, three of the five potential determinants
significantly predicted anemia: older age ≥ 85 years (OR 4.8, 95% CI 2.1–7.8, P = 0.001), longer duration of diabetes > 15 years (OR 2.9, 95% CI 1.3–to 6.2, P = 0.01), and CKD (OR 3.4, 95% CI 1.5–7.6, P = 0.002), whereas number of comorbidities and diabetes control were not significant. However, in the multivariate logistic regression analysis, only older age (OR 4.6, 95% CI 1.9–8.1, P = 0.001) and longer duration of diabetes (OR 2.9, 95% CI 1.2–6.9, P= 0.01) remained significant, whereas the effect of CKD was reduced to borderline significance (OR 2.4, 95% CI 0.96–5.7, P = 0.06).

The researchers concluded that anemia is highly prevalent in older patients with longer durations of diabetes.

Practice Pearls:

• Higher levels of anemia were seen in older patients with longer durations of diabetes.
• Chronic kidney disease was discovered to be indirect cause of anemia.
• Anemia appears to be lower in patient with average age of 65 years compared to patients with 75 years and older.

Trevest K, Treadway H, Bailey C et al. Prevalence and determinants of anemia in older people with diabetes attending an outpatient clinic: A cross-Sectional Audit. Clinical diabetes 2014; 32 (4): 158-62.