title: Erythropoietin depletion and anaemia in diabetes mellitus.
abstract: OBJECTIVE
  To discover whether Type 1 diabetic patients with autonomic neuropathy might be anaemic and erythropoietin (EPO)-depleted.
  
  
  METHODS
  Fifteen Type 1 diabetic patients with serious complications (DM-COMP) were selected because of severe symptomatic autonomic neuropathy, including significant postural hypotension. All had proteinuria from nephropathy (three microalbuminuria and 12 macroalbuminuria), but a normal serum creatinine (< 122 micromol/l). They were compared to age and duration matched Type 1 diabetic controls without autonomic neuropathy (DM-controls) and non-diabetic patients with and without hypochromic, microcytic anaemia.
  
  
  RESULTS
  The DM-COMP patients were anaemic (mean haemoglobin (Hb) 11.1+/-1.2 g/dl), sometimes severely (minimum Hb 9.2 g/dl), compared to non-neuropathic DM-controls (Hb 13.7+/-0.7 g/dl; P < 0.001). Furthermore, EPO failed to increase in association with anaemia in the DM-COMP group compared to the progressive increase in the non-diabetic, anaemic patients (difference of regression lines P < 0.001), indicating EPO depletion in the anaemic, diabetic patients. There was no other demonstrable cause for the anaemia. Treatment with EPO in 5 DM-COMP patients led to a rapid increase in haemoglobin (range 1.7-5.0 g/dl) with improvement in wellbeing.
  
  
  CONCLUSIONS
  Some Type 1 diabetic patients with autonomic neuropathy present with an EPO-depleted anaemia, which responds to treatment with EPO. This observation supports the concept of autonomic neuropathy as a cause of anaemia with EPO depletion, although the role of established renal damage cannot be excluded.
authors.affiliation: Diabetes Centre, King's College Hospital, London, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Winkler
authors.forename: J
authors.initials: J
authors.lastname: Marsden
authors.forename: K R
authors.initials: KR
authors.lastname: Chaudhuri
authors.forename: H
authors.initials: H
authors.lastname: Hambley
authors.forename: P J
authors.initials: PJ
authors.lastname: Watkins
mesh_terms: D000328:Adult; D000419:Albuminuria; D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D001342:Autonomic Nervous System Diseases / Q000150:complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D004921:Erythropoietin / Q000172:deficiency* / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D011507:Proteinuria
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin