Mini Review - Hematology and Blood Disorders (2022) Volume 5, Issue 1
A Quick note on type 2 diabetes mellitus patients with anemia
Department of Hematology, University of Greenwich, London, United Kingdom
- *Corresponding Author:
- Jacintha Sharon
Department of Hematology
University of Greenwich
London, United Kingdom
Received: 03- Jan -2022, Manuscript No. AAHBD-22-57424; Editor assigned 05- Feb -2022, PreQC No. AAHBD-22-57424(PQ); Reviewed: 19- Feb-2022, QC No AAHBD-22-57424; Revised: 22- Feb -2022, Manuscript No. AAHBD-22-57424 (R); Published: 28- Feb -2022, DOI: 10.35841/aahbd-5.1.105
Citation: Sharon J. A Quick note on type 2 diabetes mellitus patients with anemia. Hematol Blood Disord. 2022;5(1):105
Diabetes mellitus (DM) is a metabolic illness that has a global impact. According to epidemiological data, there were 285 million diabetics in the globe in 2010, and it is predicted that by 2030, there would be around 440 million diabetics. Its incidence is rapidly increasing in underdeveloped countries around the world. About 7% of the population suffers from type 2 diabetes . Type 2 diabetes mellitus (DM2) has become a major public health problem due to its rising prevalence. Due to population and urbanisation expansion, an increase in the prevalence of obesity and sedentary lifestyle, and the longer survival of diabetic patients, the number of diabetic patients has been increasing
Diabetes is a disabling condition that can lead to blindness, amputations, renal disease, anaemia, and cardiovascular and brain issues, among other things, limiting one's functional capacity and autonomy, as well as lowering one's quality of life.
Diabetes with Anemia
Type 1 diabetes mellitus (DM1) is characterized by the loss of pancreatic -cells and the absence of endogenous insulin, while type 2 diabetes mellitus (DM2) is characterized by insulin resistance and is commonly associated with obesity. Hyperglycemia is a hallmark of both kinds. Insulin resistance lowers glucose tolerance, notably in muscle cells and adipocytes, which rely on insulin for glucose uptake. This results in glucose accumulation in the circulation and, as a result, hyperglycemia, resulting in homeostatic and systemic imbalance. Diabetes is a leading cause of death due to the increased risk of acquiring cardiovascular illnesses, which account for 50 percent to 80 percent of patient fatalities due to elevated serum cholesterol and triglyceride levels. Cardiovascular illnesses are circulatory system diseases that encompass a wide spectrum of clinical syndromes . Atherosclerosis is the most common cause of atherosclerosis, which also raises the risk of acute coronary syndromes. After a period of around 7 years, the incidence of cardiovascular disease among diabetics exceeds 20%.
Hyperglycemia is linked to the onset of an inflammatory state, as evidenced by increased expression of pro-inflammatory cytokines such as IL-6, TNF-, and NF-B. As a result of its nature, diabetes, as well as hyperglycemia, is an inflammatory illness. According to studies, the higher the inflammatory process is, the longer the disease has been present and/or the glycemic control has been lost.
Increased levels of proinflammatory cytokines contribute to insulin resistance and the development of diabetic microand macrovascular problems, as well as kidney disease and anaemia. Antierythropoietic effect is induced by increasing IL-6, because this cytokine alters the sensitivity of progenitors to erythropoietin (erythroid growth factor) and promotes apoptosis of immature erythrocytes, resulting in a decrease in the number of circulating erythrocytes and, as a result, a reduction in circulating haemoglobin. It should also be highlighted that nephropathy may develop as a result of the development of diabetes mellitus, further undermining the renal production of erythropoietin and contributing to an enhanced anaemic framework. Diabetes individuals with renal disease account for about 40% of all diabetic patients. The most critical factors in influencing haemoglobin levels in those patients are impaired renal function and proinflammatory cytokines. Intestinal iron absorption and inventory mobilisation are also hampered by the inflammatory state caused by renal failure. As a result, diabetics with renal disease are at the greatest risk of acquiring anaemia [2-4].
Anemia in chronic renal disease is defined by an Hb level of less than 13, 5 g/dL in men and 12, 0 g/dL in women, according to the National Kidney Foundation. Anemia is a growing global health condition that has a negative influence on quality of life and necessitates increased healthcare spending. Reduced exercise capacity, weariness, anorexia, depression, cognitive dysfunction, decreased libido, and other characteristics are promoted by anaemic frameworks, which increase cardiac risk patients and lower their quality of life and life expectancy .Anemia in diabetic patients must be treated once recognized in these conditions, as it can contribute to the development and progression of cardiovascular disease, as well as significant diabetic nephropathy and retinopathy. Regular anaemia screening, as well as other diabetes-related problems, can help prevent the advancement of vascular issues in these patients.
Anemia in diabetics has a significant negative impact on quality of life and is linked to disease progression and the development of comorbidities such as obesity and dyslipidemia, both of which are strongly linked to the diabetic framework and contribute to an increased risk of cardiovascular disease. The goal of this study is to determine the prevalence of anaemia in a group of type 2 diabetes patients living in a city in the northwest of the state of Rio Grande do Sul who are enrolled in the Family Health Strategies programme, as well as the relationship between anaemia and demographic, lifestyle, and laboratory variables. Chronic disorders, such as diabetes, are frequently accompanied by mild-to-moderate anaemia, sometimes known as anaemia of inflammation or infection or chronic disease anaemia. Anemia in type 2 diabetic patients, as well as gene expression related to inflammation and immunological response. The authors' findings show that diabetes individuals with anaemia have higher levels of proinflammatory cytokines than diabetic patients who aren't anaemic. An increase in IL-6 production as well as B cell activity was observed in anaemic patients, confirming the link between IL-6 and antierythropoietic action. Furthermore, diabetic and anaemic patients had high levels of C-reactive protein and ferritin ultrasensible; nevertheless, these diabetic and anaemic patients had low iron levels, indicating that ferritin increases were linked to a chronic inflammatory process in diabetes.
Adipose tissue has just lately been recognized as a metabolically active organ system that connects the endocrine and immune systems, as well as a source of cytokines. Additional adjustments for blood pressure level and the presence or absence of diabetes mellitus remained a predictor of higher baseline BMI. IL-6, like TNF-alpha, is a proinflammatory adipokine that is linked to obesity and insulin resistance. The increased inflammatory activity in obese patients' adipose tissue favours the formation of hepcidin, which is enhanced during infection and inflammation in chronic illness anemia, producing a fall in serum iron levels through a mechanism that limits iron availability. Many researchers have frequently proven the link between greater iron reserves and diabetes and insulin resistance . In prospective studies and casecontrol cohorts, ferritin levels were found to predict a higher rate of diabetes. Furthermore, serum ferritin was found to be linked to BMI, visceral fat mass, blood glucose levels, insulin sensitivity, and cholesterol levels. Furthermore, this study discovered that the prevalence of hypertension among diabetes patients who were anaemic was much higher than in nonanemic diabetic patients. This link is concerning since hypertension raises the risk of cardiovascular problems in diabetics, including heart failure, stroke, tissue inflammation, and atherosclerosis.
Anemia is a common comorbidity in hypertensive patients, and when it is present; patients experience more severe symptoms, have lower functional capacity, and have a higher mortality rate. Although it is not new news that anaemia exacerbates the symptoms of hypertension, the extent of the anaemia linked with this disease has been increasingly apparent in recent years. Nutritional deficiencies particularly iron deficiency, and chronic inflammation is the main causes of anaemia in hypertensive individuals. In the current study, it was discovered that anaemia patients have lower haemoglobin, hematocrit, and red blood cell counts, which can be linked to normocytic normochromic anaemia, which is typical of chronic illness anaemia (ACD). ACD is a mild-to-moderate anaemia that causes red blood cell survival to be shortened (about 80 days instead of 120 days normal). This is due to a hyperactive condition of the mononuclear phagocyte system, which is initiated by an infectious, inflammatory, or neoplastic event and results in the elimination of circulating red blood cells early. Inadequate bone marrow response is caused by improperly low Erythropoietin (EPO) secretion, decreased bone marrow response to EPO, and decreased erythropoiesis as a result of reduced iron supply to the bone marrow.
The activation of macrophages and the release of inflammatory cytokines such as IL-1, IL-6, tumour necrosis factor (TNF a), and interferon gamma (INF g), which act by inhibiting the proliferation of erythroid precursors and thus inhibit erythropoiesis, are one explanation for this bone marrow response. Furthermore, the suppressive effect of these cytokines on erythropoiesis stimulation outweighs the effect of EPO, resulting in a reduced EPO and erythropoiesis response in the bone marrow. It's also worth noting that there was no hemoglobin-creatinine correlation or statistical differences in creatinine values and estimated glomerular filtration rate between groups, implying that chronic disease-induced anaemia is triggered by inflammation, and that reduced renal function affects EPO production .
The study's limitations include the fact that the assessment of glycemic control in diabetic patients was done using fasting glucose, which is a momentary biochemical analysis that does not represent the average glucose of patients and may also interfere with the examination, such as the effect of hypoglycemic agents that promote glucose reduction. In this regard, the gold standard for assessing glycemic control would be the achievement of HbA1c (glycated haemoglobin), which is one of the most important tools for assessing glycemic control in diabetic patients because it expresses the average amount of glucose over the previous three months and can infer diabetes control efficiency and suggest the need for adjustments.
As a result, it is advised that more research be done using test glycated haemoglobin, which is already regarded an important measure in the evaluation of DM control, to link hyperglycemia, inflammation, and anaemia. Patients with DM2 and anaemia had a high body mass index, hypertension, a larger waist circumference, and had been sick for a longer duration. This set of alterations classifies anaemia as a chronic condition that has a major negative impact on diabetic patients' quality of life and is linked to disease progression; the development of comorbidities adds considerably to the increased risk of cardiovascular disease. However, contrary to expectations, nonanemic individuals' blood glucose levels were greater, which is counterintuitive given that their anaemia is associated with an inflammatory illness and is classified as normocytic normochromic anaemia. Increasing the research and correlation of some analytical parameters, such as HbA1c, I1-6, VHS, and PCR, by deepening the study of the issues raised throughout this work provides knowledge for the establishment of new glycemic control strategies, which can increase the research and correlate some analytical parameters, such as HbA1c, I1-6, VHS, and PCR.
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