title: Prevalence and nature of anaemia in a prospective, population-based sample of people with diabetes: Teesside anaemia in diabetes (TAD) study.
abstract: OBJECTIVE
  Anaemia occurs in 25% of people attending hospital diabetes clinics, but this may not be representative of all people with diabetes. We aimed to determine the prevalence of anaemia in a prospective population-based sample stratified by estimated glomerular filtration rate (eGFR) using the 4-point Modification of Diet in Renal Disease (MDRD) formula.
  
  
  METHODS
  All 7331 patients on our district register were stratified by eGFR. Seven hundred and thirty were approached by letter on two occasions. Two hundred and thirty-four (32%) returned questionnaires and blood samples. Responders (R), non-responders (NR) and the whole cohort (C) were similar: mean +/- sd age R 61.7 +/- 12.7 years; NR 61.3 +/- 15.1 years; C 61.8 +/- 14.2 years; diabetes duration R 8.8 +/- 8.6 years; NR 8.2 +/- 7.9 years; C 7.5 +/- 7.8 years, Type 1 diabetes R 10.1%, NR 10.8%, C 9.4%. Anaemia was defined using World Health Organization criteria: haemoglobin < 13 g/dl for men, < 12 g/dl for women.
  
  
  RESULTS
  Previously undiagnosed anaemia was present in 15% of the whole group, 36% with eGFR < 60 ml/min per 1.73 m(2) and 9% of those with eGFR > 60 ml/min per 1.73 m(2). Anaemia was as a result of erythropoietin deficiency in 34%, abnormal haematinics in 40% and was unexplained in 26% of patients. Five per cent of the patients had anaemia below the treatment threshold of 11 g/dl.
  
  
  CONCLUSIONS
  The prevalence of unrecognized anaemia in population-based cohorts is lower than that in hospital-based studies. Current clinical surveillance in the UK is failing to detect anaemia in stage 3-5 chronic kidney disease (eGFR < 60 ml/min per 1.73 m(2)) and current guidelines will not detect 9% of diabetic patients with anaemia and an eGFR > 60 ml/min per 1.73 m(2).
authors.affiliation: William Kelly Diabetes Centre, James Cook University Hospital, Middlesbrough, UK. stephen.jones@stees.nhs.uk
authors.forename: S C
authors.initials: SC
authors.lastname: Jones
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Nag
authors.forename: M T
authors.initials: MT
authors.lastname: Bilous
authors.forename: S
authors.initials: S
authors.lastname: Winship
authors.forename: A
authors.initials: A
authors.lastname: Wood
authors.forename: R W
authors.initials: RW
authors.lastname: Bilous
mesh_terms: D000368:Aged; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D004921:Erythropoietin; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006397:Hematinics; D006801:Humans; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D006397:Hematinics; D004921:Erythropoietin