Sickle Cell Disease and Diabetes Mellitus

Is there a link between patients living with sickle cell disease and diabetes mellitus?

African-Americans/ Black are the most affected by sickle cell disease (SCD). According to the US Department of Health and Human Services Office of Minority Health, this population also has the highest prevalence of obesity. Sickle cell disease has been associated with many comorbidities. Progressive retinopathy, chronic kidney failure, chronic disabling arthritis, stroke, and premature death are reported in patients with sickle cell disease because they experience recurrent vaso-occlusive crisis. Hydroxyurea and blood transfusions remain the first-line treatment in patients with severe acute chest syndrome. However, hydroxyurea does not provide cardiopulmonary complication protection. Cardiopulmonary complications are one of the significant causes of death in sickle cell disease. This study wants to assess the prevalence of obesity and diabetes in African American/ blacks living with sickle cell disease and how this impacts the multimorbidity seen in sickle cell disease patients.

Researchers obtained patient’s information from a medical record survey of sickle cell disease patients at an institution. The International Classification of Disease code D57 was used to identify all patients with sickle cell disease electronically. To determine if a patient were obese, the mass body index was used as reported by the treating physicians. The patient’s endocrinologist or primary care physician determined the patient’s diabetes status.

Data collected from the US Department of Health and Human Services Office of Minority Health on obesity and diabetes were analyzed using the Chi-square test in two comparator groups. Kaplan-Meier method was used to assess cumulative risk for obesity and diabetes and plotted as a time-dependent covariate.

The study cohort consists of 449 patients with sickle cell disease, with 258 females and 191 males. The median age of participants was 39 years. Patients in this study’s phenotypes were HbSS 63%, HbSC 22.5%, HbSβ⁰thal 12%, and the remaining patient’s phenotypes were unknown.

Patients with sickle cell disease that were obese in this study were 9.2%, which is low. Males over 18 that were obese was 5.2%, while females who were obese in this study was 15%, while 0% of patients between the age of 6-17 years old were obese. The probability that patients with sickle cell disease will become obese increases progressively in males 30-50 years and 25-60 years old in females. There was no difference in prevalence rate between the different types of phenotypes.

Diabetes mellitus and obesity were not prevalent in patients with sickle cell disease in this study. Only 5.6% of patients over 18 were diagnosed with diabetes mellitus. The likelihood that obese patients 18 and older would develop diabetes mellitus was greater than in patients who were not obese. Patients in this study only had type 2 diabetes and not type 1. The probability of persons developing diabetes mellitus increases progressively between the ages of 45 and 70 years.

The prevalence of patients living with sickle cell disease who are also obese was low. It is still unclear why this is the case, but speculated that this occurs because of lower nutritional intake. However, there are study’s that report no difference in diet and energy intake of children and adults with the disease compared with those without it. Another explanation is that patients with sickle cell disease have lower amounts of intestinal Alistipes and Pseudobutyribrio which prevents the development of obesity. It is also possible that intestinal malabsorption may be responsible for low obesity rates. Patients with sickle cell disease also have hypermetabolism which increases energy use and may prevent weight gain.

There was a low rate of obesity in sickle cell disease patients, which is related to a low rate of patients developing type II diabetes. It is safe to suggest that a low incidence of obesity correlates to a low incidence of type II diabetes. Future studies need to be done to understand the lower prevalence of obesity and diabetes in patients living in sickle cell disease.

• Persons living with sickle cell disease have a low risk of developing Type II diabetes and becoming obese.
• There is a correlation between obesity and type II diabetes, even in patients with sickle cell disease.
• Lower nutritional intake may be responsible for the low prevalence of obesity in patients living with type II diabetes.

Jang, Tim et al. “Obesity and diabetes mellitus in patients with sickle cell disease.” Annals of hematology vol. 100,9 (2021): 2203-2205. doi:10.1007/s00277-021-04578-w

Jerrine Fletcher, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health