Anemia associated with new-onset diabetes: improvement with blood glucose control.
OBJECTIVE
To evaluate the mild normochromic normocytic anemia associated with new-onset diabetes in young, otherwise healthy patients.


METHODS
We undertook a retrospective review of medical records of patients with new-onset diabetes and unexplained anemia. Anemia was defined as a hemoglobin concentration of less than 12.5 g/dL in women and less than 14 g/dL in men. Patients with obvious causes of anemia, such as renal insufficiency, infection, pancreatitis, deficiency of glucose-6-phosphate dehydrogenase, hemolysis, or acute or chronic blood loss, were excluded from the study.


RESULTS
In 16 otherwise seemingly healthy patients with new-onset diabetes, a normochromic normocytic anemia (mean corpuscular volume, 86.4 +/- 4 fL) was diagnosed at initial assessment. These 16 patients (8 men and 8 women) had a mean age of 33 +/- 10 years. At diagnosis, the mean glycated hemoglobin (HbA1c) was 15.5 +/- 3.4%, the mean hemoglobin concentration was 12.5 +/- 0.6 g/dL, and the mean hematocrit was 36.2 +/- 2%. All patients were treated with insulin. After a mean follow-up of 10.8 +/- 17 months, insulin treatment resulted in a decline in HbA1c to 7.7 +/- 1.7% (P<0.001; confidence interval [CI], 5.7 to 9.8). The hemoglobin concentration increased to 14.3 +/- 0.9 g/dL (P<0.001; CI, 1.22 to 2.38), and the hematocrit increased to 42.1 +/- 1.9% (P<0.001; CI, 3.59 to 7.04). All patients had hemoglobin AA and normal levels of hemoglobin A2. Men and women had equal improvement in hematologic variables after improvement in glycemic control.


CONCLUSIONS
Some patients with new-onset diabetes have a mild normochromic normocytic anemia that is not attributable to usual causes, such as infection, pancreatitis, or blood loss. Improvement in glycemic control tends to be associated with normalization of hemoglobin levels. The cause of such cases of anemia may be either direct "glucose toxicity" to erythrocyte precursors in the bone marrow or perhaps oxidative stress to mature erythrocytes.
Piñero-Piloña
Antonio
A
Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390-8858, USA.
Litonjua
Patrick
P
Devaraj
Sridevi
S
Aviles-Santa
Larissa
L
Raskin
Philip
P
D000328:Adult; D000740:Anemia / Q000150:complications* / Q000175:diagnosis; D001786:Blood Glucose / Q000032:analysis*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy*; D004909:Erythrocyte Indices; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D007328:Insulin