title: Newly diagnosed anemia in admitted diabetics, frequency, etiology and associated factors.
abstract: OBJECTIVE
  To determine the frequency of newly-diagnosed anemia in diabetics admitted to the Internal Medicine Department and its etiology and contributing factors.
  
  
  METHODS
  A cross-sectional, analytical study.
  
  
  METHODS
  Department of Internal Medicine, Sir Syed Trust Hospital and College of Medical Sciences, Karachi, from July 2011 to December 2012.
  
  
  METHODS
  Adult diabetic patients first diagnosed as having anemia upon hospital admission during the specified duration were included. Patients with active bleed, acute renal impairment, critical illness, pregnancy and previously diagnosed anemia were excluded. Etiology and risk factors of anemia were determined in each case on the basis of history, clinical findings and relevant laboratory investigations i.e. complete blood picture, red cell indices, iron profile, renal function tests, urine and stool examination. Association of anemia was determined using chi-square and t-tests with p-value < 0.05 taken as significant.
  
  
  RESULTS
  One hundred and thirty patients (34 males and 96 females) were included. Mean age was 51 ± 12.4 years, with mean BMI of 25.4 ± 5.2 kg/m2, mean duration of diabetes of 7.6 ± 5.5 years and mean glycated haemoglobin (HbA1c) 8.47 ± 1.58%, with 75% diabetics having unsatisfactory glycemic control. Mean haemoglobin was 11.6 ± 1.96 g/dl. Anemia was present in 63% diabetics (18 males and 64 females). It was normocytic in 59.8%, microcytic in 37.8% and macrocytic in 2.4%. Chronic Kidney Disease (CKD) was present in 44%, iron deficiency in 23%, mixed etiology in 6%, vitamin B-12 deficiency in 2% and thalassemia minor in 1% cases. Statistically significant association of anemia was found with poor glycemic control (p=0.002), dietary restriction for red meat (p < 0.001), history of blood loss (p < 0.001), gastrointestinal disorders (p < 0.001), CKD (p < 0.001) and retinopathy (p=0.011).
  
  
  CONCLUSIONS
  Anemia in two out of every three diabetics in this study points to need for haematological screening in all diabetics presenting to healthcare facility. In addition to chronic kidney disease, dietary iron and vitamin deficiency, glycemic control, presence of CKD, retinopathy and gastrointestinal disorders need to be evaluated and rectified.
authors.affiliation: Department of Internal Medicine, Sir Syed College of Medical Sciences and Sir Syed Trust Hospital, Karachi.
authors.forename: Nadia
authors.initials: N
authors.lastname: Shams
authors.affiliation: Department of Internal Medicine, Sir Syed College of Medical Sciences and Sir Syed Trust Hospital, Karachi.
authors.forename: M H
authors.initials: MH
authors.lastname: Osmani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007501:Iron / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007501:Iron