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Agarwal H, Kapoor G, Sethi P, Ghosh T, Pandey S, Sehgal T, Meena VP, Ranjan P, Vikram NK. Anemia and its association with glycemia and transaminitis in patients with type 2 diabetes mellitus: A cross-sectional pilot study. J Family Med Prim Care 2024; 13:2972-2978. [PMID: 39228604 PMCID: PMC11368274 DOI: 10.4103/jfmpc.jfmpc_1601_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 09/05/2024] Open
Abstract
Background and Aims Anemia impairs glucose homeostasis, affects glycemic control, and predisposes to complications in diabetics. It correlates with oxidative stress and increases the risk of developing microvascular and macrovascular complications. However, it is an underrecognized comorbidity in diabetics. This study was conducted to assess the prevalence of anemia in diabetic patients and compare the metabolic profiles of anemic and non-anemic diabetics. Methods This is a cross-sectional study, conducted among type 2 diabetes (T2DM) patients, at the outpatient clinic. Patients with chronic kidney disease (CKD), known hematological disorders, and chronic inflammatory disorders were excluded. Results Of the 97 patients, 37 (38.14%) were found to be anemic (hemoglobin (Hb): male <13 g/dl, female <12 g/dl). The mean values of fasting blood sugar (FBS) in low and normal mean corpuscular volume (MCV) patients were 265.9 ± 43.7 mg/dl and 157.2 ± 7.2 mg/dl, respectively (P = 0.0026), and those of postprandial blood sugar (PPBS) were 370.3 ± 58.4 mg/dl and 226.3 ± 10.1 mg/dl, respectively (P = 0.0015). It was found that 6 (22.2%) of 27 patients with raised alanine aminotransferase (ALT) had anemia against 27 (45.8%) of 59 patients with normal ALT (P = 0.03). The mean Hb levels in patients with raised and normal ALT were 13.31 ± 2.3 gm% and 12.2 ± 2.0 gm% (P = 0.03), respectively. Conclusions Blood sugar may have a direct relationship with MCV in T2DM patients. Hb tends to relate to hepatic enzymes likely due to altered dietary patterns in anemics. Further larger studies on the effect of iron supplementation and dietary habits on glycemic control and hepatic steatosis are warranted.
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Affiliation(s)
- Harsh Agarwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Kapoor
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prayas Sethi
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Sehgal
- Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved P. Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Okada A, Yamaguchi S, Imaizumi T, Oba K, Kurakawa KI, Yamauchi T, Kadowaki T, Nangaku M. Modification Effects of Albuminuria on the Association Between Kidney Function and Development of Anemia in Diabetes. J Clin Endocrinol Metab 2024; 109:1012-1032. [PMID: 37955878 PMCID: PMC10940265 DOI: 10.1210/clinem/dgad660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
CONTEXT Previous studies failed to adjust for estimated glomerular filtration rate (eGFR) in evaluating the association between albuminuria and anemia development, and we aimed to investigate whether albuminuria independently affects anemia development. METHODS We conducted a retrospective cohort study and retrospectively identified adults with diabetes from a Japanese nationwide clinical database (JMDC, Tokyo, Japan). To assess the modification effects of albuminuria on the association between eGFR and anemia development, we estimated prevalence of anemia, defined as hemoglobin < 13 g/dL in men and < 12 g/dL in women, using a modified Poisson regression and marginal standardization form of predictive margins, stratified by albuminuria severity after adjusting for eGFR. Hence, we revealed at which eGFR level this modification effect appeared and the extent to which this modification effect increased the prevalence of anemia. RESULTS We identified 327 999 data points from 48 056 individuals [normoalbuminuria: 186 472 (56.9%), microalbuminuria: 107 170 (32.7%), and macroalbuminuria: 34 357 (10.5%)]. As eGFR declined, anemia prevalence increased. Albuminuria severity modified this association induced by decreased eGFR among individuals with eGFR <30 mL/min/1.73 m2 after adjusting for multivariable factors, including age, sex, comorbidities, and medication use. Compared with the normoalbuminuric group, the macroalbuminuric group had a 5% to 20% higher anemia prevalence among individuals with eGFR of <30 mL/min/1.73 m2. CONCLUSION We revealed that the severity of albuminuria modified the association between eGFR and anemia development among individuals with eGFR <30 mL/min/1.73 m2, highlighting the modification effect of albuminuria on the association between kidney function and anemia development in diabetes.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan
| | - Koji Oba
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of TokyoTokyo, 113-8655, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of TokyoTokyo, 113-8655, Japan
- Toranomon Hospital, Tokyo 105-8470, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Taderegew MM, Wondie A, Terefe TF, Tarekegn TT, GebreEyesus FA, Mengist ST, Amlak BT, Emeria MS, Timerga A, Zegeye B. Anemia and its predictors among chronic kidney disease patients in Sub-Saharan African countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0280817. [PMID: 36730249 PMCID: PMC9894480 DOI: 10.1371/journal.pone.0280817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Anemia is a serious complication of chronic kidney disease (CKD) with a significant adverse outcome on the burden and progression of the disease. Hence, the study intended to assess the pooled prevalence of anemia and its predictors among CKD patients in Sub-Saharan African nations. METHODS To identify the relevant studies systematic searches were carried out in Medline, EMBASE, HINARI, Google Scholar, Science Direct, and Cochrane Library. From selected studies, data were taken out with a standardized data extraction format prepared in Microsoft Excel. Inverse variance (I2) tests were employed to evaluate the heterogeneity across the included studies. Due to substantial heterogeneity among the studies, a random-effects meta-analysis technique was employed to estimate the pooled prevalence of anemia. Subgroup analysis, sensitivity analysis, and meta-regression analysis were carried out to search the possible bases of heterogeneity. Funnel plot symmetry, Begg's test, and Egger's regression test were employed to assess the existence of publication bias. In addition, factors associated with anemia among CKD patients were examined. All statistical analyses were carried out with STATA™ Version 14 software. RESULTS A total of 25 studies with 5042 study participants were considered in this study. The pooled prevalence of anemia among CKD patients was estimated to be 59.15% (95% CI, 50.02-68.27) with a substantial level of heterogeneity as evidenced by I2 statistics (I2 = 98.1%; p < 0.001). Stage of CKD (3-5) (pooled odds ratio (POR) = 5.33, 95% CI:4.20-6.76), presence of diabetes mellitus (POR = 1.75, 95% CI: 1.10-2.78), hemodialysis history (POR = 3.06, 95% CI: 1.63-5.73), and female sex (POR = 2.50, 95% CI: 1.76-3.55) were significantly related with anemia. CONCLUSIONS More than half of CKD patients were suffering from anemia. Stage of CKD, presence of DM, hemodialysis history, and being female sex were factors associated with anemia among CKD patients.
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Affiliation(s)
- Mitku Mammo Taderegew
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia,* E-mail:
| | - Alemayehu Wondie
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tamene Fetene Terefe
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tadesse Tsehay Tarekegn
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Fisha Alebel GebreEyesus
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Shegaw Tesfa Mengist
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Baye Tsegaye Amlak
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Mamo Solomon Emeria
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Abebe Timerga
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
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Kindie E, Getachew M, Abebaw A, Yihunie W, Biyazin Y, Tegegne BA, Abebe D, Akalu TY, Atnaf A. Magnitude of anemia and associated factors among adult patients at Baso Liben District: a cross-sectional study. Expert Rev Hematol 2023; 16:75-80. [PMID: 36382572 DOI: 10.1080/17474086.2023.2147499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the fact that anemia is a common health problem with many consequences, its magnitude among adults and the different contributing factors have not been documented in the study setting. Hence, this study aimed to determine the magnitude of anemia and associated factors among adult patients of Baso Liben District. METHODS A facility-based cross-sectional study was conducted from 1 December 2019, to February 30, 2020. A total of 347 adult patients attending Yejubie Hospital were enrolled in the study. Socio-demographic data were collected through face-to-face interview. Patients' hemoglobin level was determined by a Mindray BC-5800 CBC hematology analyzer. The presence of intestinal parasites and malaria infection were assessed. RESULTS The overall magnitude of anemia was 25.94% with moderate severity according to the WHO anemia classification. The prevalence of mild, moderate, and severe anemia was 13.54%, 8.36%, and 4.03%, respectively. Anemia was associated with age range ≥55 years (AOR = 31.66), large family size (AOR = 6.62), being married (AOR = 0.24), intestinal parasite infections (AOR = 4.05), malaria infection (AOR = 4.61), and pregnancy (AOR = 4.09). CONCLUSION The prevalence of anemia was moderate. Intestinal parasitic infection, age, malaria, family size, and pregnancy were associated factors with anemia.
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Affiliation(s)
- Enyew Kindie
- Department of Medical Laboratory Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Melese Getachew
- Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Abtie Abebaw
- Department of Medical Laboratory Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Wubetu Yihunie
- Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yalemgeta Biyazin
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bantayehu Addis Tegegne
- Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dehnnet Abebe
- Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadesse Yirga Akalu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Aytenew Atnaf
- Department of Medical Laboratory Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Getawa S, Adane T. Hematological abnormalities among adults with type 1 diabetes mellitus at the University of Gondar Comprehensive Specialized Hospital. SAGE Open Med 2022; 10:20503121221094212. [PMID: 35492887 PMCID: PMC9047808 DOI: 10.1177/20503121221094212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: Changes in the blood cell function, metabolism, and the coagulation system
were associated with diabetes mellitus. This study aimed to determine the
magnitude and associated factors of hematological abnormalities in adults
with type 1 diabetes mellitus. Methods: A total of 204 medical charts of adults with type 1 diabetes mellitus who
registered for follow-up at the University of Gondar Comprehensive
Specialized Hospital were reviewed from June to August 2021. Data were
collected using a structured data extraction checklist. To identify factors
associated with hematological abnormalities, both bivariate and multivariate
logistic regression analyses were done. Statistical significance was defined
as a p-value of <0.05. Results: The overall magnitude of leukocytosis and anemia in adults with type 1
diabetes mellitus was 76.0% (95% confidence interval: 70.07–81.89) and
30.90% (95% confidence interval: 24.49–37.28), respectively. Neutrophilia
and lymphocytosis were the common white blood cell abnormalities detected in
53.43% (95% confidence interval: 46.53–60.33) and 43.63% (95% confidence
interval: 36.76–50.49) of the patients, respectively. Besides,
thrombocytosis and thrombocytopenia were observed in 5.4% (95% confidence
interval: 2.27–8.52) and 10.3% (95% confidence interval: 6.09–14.5) of the
patients, respectively. Only being male (adjusted odds ratio = 2.28 (95%
confidence interval: 1.46–5.29)) and duration of diabetes mellitus
(⩾3 years) (adjusted odds ratio = 8.41 (95% confidence interval:
2.49–28.29)) were significantly associated with anemia and leukocytosis,
respectively. Conclusion: Hematological abnormalities, particularly anemia and leukocytosis, are common
in patients with type 1 diabetes mellitus. Therefore, preventive and control
strategies for hematological abnormalities are essential in patients with
type 1 diabetes mellitus particularly for male and patients with a long
duration on diabetes mellitus to reduce the burden and related
complications.
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Affiliation(s)
- Solomon Getawa
- Solomon Getawa, Department of Hematology
and Immunohematology, School of Biomedical and Laboratory Sciences, College of
Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Ni W, Yuan X, Sun Y, Zhang H, Zhang Y, Xu J. Anaemia and associated factors among older adults in an urban district in China: a large-scale cross-sectional study. BMJ Open 2022; 12:e056100. [PMID: 35264361 PMCID: PMC8915324 DOI: 10.1136/bmjopen-2021-056100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Anaemia leads to poor health outcomes in older adults; however, most current research in China has focused on younger adults. This study aimed to investigate the prevalence of anaemia and its associated factors in older adults in an urban district in China. DESIGN A cross-sectional study. SETTING An urbanised region, Shenzhen, China. PARTICIPANTS A total of 121 981 participants aged ≥65 years were recruited at local community health service centres in Shenzhen from January to December 2018. PRIMARY OUTCOMES The prevalence of anaemia was analysed and potential associated factors were evaluated. RESULTS The mean haemoglobin level was 136.40±16.66 g/L and the prevalence of anaemia was 15.43%. The prevalences of mild, moderate and severe anaemia were 12.24%, 2.94% and 0.25%, respectively. Anaemia was positively associated with older age, being underweight (adjusted OR (AOR) 2.06, 95% CI 1.93 to 2.20), diabetes (AOR 1.23, 95% CI 1.19 to 1.28) and chronic kidney disease (AOR 1.41, 95% CI 1.36 to 1.46), and inversely with higher education level, current-smoker (AOR 0.84, 95% CI 0.78 to 0.89), non-habitual drinker (AOR 0.86, 95% CI 0.81 to 0.92), habitual drinker (AOR 0.81, 95% CI 0.75 to 0.87), overweight (AOR 0.67, 95% CI 0.64 to 0.70), obesity (AOR 0.57, 95% CI 0.53 to 0.61), central obesity (AOR 0.86, 95% CI 0.82 to 0.89), hypertension (AOR 0.86, 95% CI 0.83 to 0.89) and dyslipidaemia (AOR 0.81, 95% CI 0.78 to 0.84). CONCLUSION Anaemia is prevalent among people aged 65 years and older in China. Screening of high-risk populations and treatment of senile anaemia should be a top priority in Shenzhen, and should be listed as important public health intervention measures for implementation.
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Affiliation(s)
- Wenqing Ni
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xueli Yuan
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yuanying Sun
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Hongmin Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Yan Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Jian Xu
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
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Solomon D, Bekele K, Atlaw D, Mamo A, Gezahegn H, Regasa T, Negash G, Nigussie E, Zenbaba D, Teferu Z, Nugusu F, Atlie G. Prevalence of anemia and associated factors among adult diabetic patients attending Bale zone hospitals, South-East Ethiopia. PLoS One 2022; 17:e0264007. [PMID: 35180254 PMCID: PMC8856574 DOI: 10.1371/journal.pone.0264007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/31/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Anemia found in diabetes patients is often unrecognized like many other chronic diseases. The occurrence of anemia is also an additional burden to the micro vascular complications of patients with diabetes. In the selected study structure no published data were found on the prevalence of anemia and associated factors in diabetic patients. Hence, the findings of this study are very fruitful as an input for further studies and after the repetition of similar studies in different frameworks. It is helpful as input for the development of guidelines at diabetes clinics to request the laboratory assessment of hemoglobin as a routine activity. OBJECTIVE This study aimed to assess the prevalence of anemia and its associated factors among diabetic patients who attended Bale zone hospitals. METHODS A cross-sectional study design was conducted from September 2020-to January 2021 GC among adult diabetic patients who had follow-up at Bale zone hospitals. A total of 238 study participants were determined by single population proportion sample size calculation formula taking prevalence of anemia among adult diabetic patients 19.0%. Systematic random sampling technique was used to select the study participants. Information on demographic and associated factors of anemia in diabetic patients was collected using an interviewer-administered questionnaire. Blood sample collection was performed under aseptic conditions by a licensed medical laboratory professional. Data were entered into EpiData version 3.1, cleaned and exported to statistical package for the social sciences (SPSS) version 25 software tools. Logistic regression was used to assess factors associated with anemia in diabetic patients. P-value less than 0.05 and 95% CI were considered as statistically significant. The odds ratios were reported to indicate the strength of associations. Frequencies, percentages, charts and tables were used to summarize the characteristics of study participants. RESULTS In this study anemia among adult diabetic patients is 18.1% (95% CI (13.2, 23.0%). Multivariable logistic regression analysis revealed that the sex of the study participants and the type of diabetes mellitus were found to be statistically significant to associate with anemia. The odds of having anemia among females are nearly three times higher when compared with males (AOR 2.78, 95% CI 1.40-5.52). In addition, the odds of having anemia among adult diabetic patients who had type II diabetes mellitus (AOR 2.18, 95%CI 1.04-4.54) were 2.18 times higher than those who had type I diabetes mellitus patients. CONCLUSION Nearly one out of five adult diabetic patients had anemia. Sex of the patients and the type of diabetes are associated with anemia among adult diabetic patients.
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Affiliation(s)
- Damtew Solomon
- Anatomy Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Daniel Atlaw
- Anatomy Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Habtamu Gezahegn
- Physiology Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Tadele Regasa
- Biochemistry Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Getahun Negash
- Medical Laboratory Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Eshetu Nigussie
- Medical Laboratory Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Demissu Zenbaba
- Public Health Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Fikadu Nugusu
- Public Health Department, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Gela Atlie
- Internal Medicine Department, Madda Walabu University, Goba, Oromia, Ethiopia
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Tesfaw HM. Anemia among Chronic Kidney Disease Patients at St. Paulo's Hospital Millennium Medical College, Addis Ababa, Ethiopia. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:S61-S65. [PMID: 37102525 DOI: 10.4103/1319-2442.374383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Anemia is a condition in which the body has fewer red blood cells than normal. Chronic kidney disease (CKD) patients are people with permanent or partial loss of kidney functions. Renal Anemia affects patients with CKD. Knowing the prevalence of anemia among CKD patients is important for patients' treatment as well as further investigation of root cause of anemia in CKD patients. The aim of this study is to assess the prevalence of anemia among CKD at the renal outpatient department unit of St. Paulo's Hospital Millennium Medical College, Addis Ababa, Ethiopia. A retrospective study was conducted to collect the data of CKD patients from March 2016 to April 2018 at St. Paulo's Hospital Millennium Medical College. Data were collected using structural data collection and analyzed using IBM SPSS Statistics version 20.0 software. P value is used to assess the association of variables. A total of 352 CKD patients were involved in this study. The prevalence of anemia was 65.91% among CKD patients at St. Paulo's Millennium Medical College Hospital. Diabetes and hypertension (HTN) are high in anemic CKD patients 33.81% and 36.36%, respectively. Majority of these anemic CKD patients were from residency of rural areas (35.23%) and within the age group of 49-58 years (67.3%). There is a high prevalence of anemia among chronic kidney patients which is 65.91% among CKD patients. Among anemic patients, diabetes and HTN are high, and these could be risk factors for anemia. However, it needs further investigations to determine cause-effect relationship.
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Affiliation(s)
- Habtamu Molla Tesfaw
- Department of Medical Laboratory Science, Addis Ababa University, College of Health Science, Addis Ababa, Ethiopia
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Olum R, Bongomin F, Kaggwa MM, Andia-Biraro I, Baluku JB. Anemia in diabetes mellitus in Africa: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102260. [PMID: 34479102 DOI: 10.1016/j.dsx.2021.102260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
AIMS Anemia accelerates chronic complications of diabetes mellitus (DM). We aimed to conduct a systematic review and meta-analysis to estimate the prevalence of anemia among people with DM in Africa. METHODS A search of studies was conducted in the main databases (Medline, EMBASE, Scopus, CINAHL, AJOL and Google Scholar) and the reference lists of selected studies. Observational studies that met the eligibility criteria were included in this meta-analysis. There was no limitation in terms of language. RESULTS We obtained data from 27 eligible studies, including 5913 patients. The pooled prevalence of anemia was 35% (95% CI: 28%-42%, I2 = 97.7%, p < 0.01). In sub-group analysis, the pooled prevalence was higher in people with diabetic foot lesions (56%, 95% CI: 49%-63%, I2 = 51.04%, p = 0.100) than in the general population of people with diabetes (30%, 95% CI: 23%-37%, I2 = 97.6%, p < 0.01). Pooled prevalence rates were also higher in; males than females (34% vs 31%), type II DM than type I DM (35% vs 26%), and in patients with poor glycemic control compared to those with good glycemic control (33% vs. 22%). CONCLUSIONS The prevalence of anemia in DM was high warranting enhanced clinical and public health interventions.
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Affiliation(s)
- Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Atlaw D, Tariku Z. Magnitude and factors associated with anemia among diabetic patients in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2021; 9:20503121211031126. [PMID: 34290867 PMCID: PMC8274127 DOI: 10.1177/20503121211031126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/21/2021] [Indexed: 12/16/2022] Open
Abstract
Background: In Ethiopia, diabetes is estimated to affect about half a million people. About 35% of individuals with diabetes are complicated by microvascular diseases like retinopathy, nephropathy, cardiovascular, and anemia. Even though there are some studies conducted on prevalence and associated factors of anemia in diabetic patients, their findings were variable. Therefore, this meta-analysis is aimed to determine the pooled prevalence and factors associated with anemia among diabetic patients. Methods: PubMed, CINAHL, POPLINE, ScienceDirect, African Journals Online, and Google Scholar were systematically searched to identify related studies. The heterogeneity of studies was assessed using Cochran’s Q test and I2 tests. A random-effects model was used to estimate the pooled prevalence of anemia among diabetic patients in Ethiopia. Publication bias was evaluated by employing Egger’s tests. Results: After reviewing 503 articles, 6 articles fulfilled inclusion criteria and remained for the final meta-analysis. The pooled prevalence of anemia among diabetic patients was 24.81% (95% confidence interval: 19.38–30.25). Age greater than 60 years old (pooled odds ratio, 95% confidence interval: 3.73 (2.23–6.77)), glomerular filtration rate less than 60 mL/min/1.73 m2 (pooled odds ratio, 95% confidence interval: 12.65 (8.71–18.37)), and being diabetic for more than 10 years (pooled odds ratio, 95% confidence interval: 10.21 (7.00–15.04)) were found to be determinants of anemia among diabetic patients in Ethiopia. Conclusion: Overall, one in four diabetic patients develops anemia in Ethiopia. Age, glomerular filtration rate, and duration of being diabetic are factors significantly associated with the occurrence of anemia in diabetic patients.
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Affiliation(s)
- Daniel Atlaw
- Department of Anatomy, School of Medicine, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Zerihun Tariku
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Arkew M, Yemane T, Mengistu Y, Gemechu K, Tesfaye G. Hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia: A comparative cross-sectional study. PLoS One 2021; 16:e0253286. [PMID: 34125859 PMCID: PMC8202906 DOI: 10.1371/journal.pone.0253286] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes is a global public health problem and associated with metabolic, cellular, and blood disturbances. Hematological changes have been reported in diabetes and play a major role in diabetes-associated complications. However, reports are contradicting and data on hematological parameters of type 2 diabetic patients in the study area are scarce. Therefore, the aim of this study was to assess the hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia from May 01 to June 30, 2020. METHODS A comparative cross-sectional study was conducted on 268 (134 type 2 diabetic patients and 134 controls) study participants selected by systematic random sampling technique. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire and checklist. Ethical approval was obtained from Jimma University. All phase of quality assurance was maintained. Hematological parameters and blood glucose levels were determined using UniCel DxH 800 (Beckman Coulter, USA) and Biosystems A25 (Costa Brava, Spain) analyzers, respectively. Independent t-test, Mann-Whitney U-test, correlation, and logistic regression were used during data analysis. P-value <0.05 was considered as statistically significant. RESULTS The current study found that total white blood cell count, absolute counts of neutrophil, lymphocyte, eosinophil, and basophil, red blood cell distribution width, platelet count, and mean platelet volume were significantly higher in type 2 diabetic patients as compared to the control group (P<0.05). On the other hand, the mean hemoglobin was significantly lower in type 2 diabetic patients than the control group (P = 0.007). Anemia was found in 17.9% of type 2 diabetic patients. Longer duration of diabetes (AOR = 3.05, 95% CI = 1.12-8.34) and milk consumption (AOR = 4.60, 95% CI = 1.50-14.00) were significantly associated with anemia. CONCLUSION This study showed a statistically significant variation in some hematological parameters of type 2 diabetic patients compared to control group. Anemia among type 2 diabetic patients was found to be a mild public health problem. Therefore, routine screening of hematological parameters should be considered for proper management of type 2 diabetic patients. Close attention should also be given to the duration of diabetes and dietary practice.
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Affiliation(s)
- Mesay Arkew
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Yemane
- Faculty of Health Sciences, School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yordanos Mengistu
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Gemechu
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Girum Tesfaye
- Faculty of Health Sciences, School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Adane T, Getawa S. Anaemia and its associated factors among diabetes mellitus patients in Ethiopia: A systematic review and meta-analysis. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00260. [PMID: 34277984 PMCID: PMC8279623 DOI: 10.1002/edm2.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
Introduction Anaemia is common but often overlooked in diabetes mellitus (DM) patients. There is also no official nationwide survey registry that estimated the prevalence of anaemia in DM patients in Ethiopia. Therefore, the main aim of this study is to determine the countrywide pooled prevalence and associated factors of anaemia in DM patients. Methods This systematic review and meta‐analysis were conducted as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. STATA 11 software was used for all statistical analysis. Random effects model was used to estimate the pooled prevalence of anaemia and associated factors at a 95% confidence interval (CI) with its respective odds ratio (OR). Subgroup analysis and egger test were used to determine heterogeneity and publication bias, respectively. Results Nine articles were included in this systematic review and meta‐analysis with a total of 2889 DM patients. The pooled prevalence of anaemia among DM patients in Ethiopia was 22.11% (95% CI: 15.83–28.39) I2 = 94.8%. The prevalence of anaemia in type I and type II DM patients was (16.78% [95% CI: 11.53–22.04]) and (31.12% [95% CI; 9.66–52.58]), respectively. The prevalence of anaemia was higher among male (36.72% [95% CI: 22.58–50.87] I2 = 97.6%) than female (27.51% [95% CI: 16.12–38.90] I2 = 96.3%). Moreover, the odds of anaemia were higher among patients with age ˃ 60 (OR = 2.98; 95% CI: 1.83, 4.87), low estimated glomerular filtration rate (eGFR) (OR = 8.59; 95% CI: 4.76, 15.57), and duration of illness ≥5 years (OR = 2.66; 95%: 1.38, 5.13). Conclusions The result of this review implies that anaemia is a moderate public health problem among DM patients in Ethiopia. Older age, poor glycemic control, low eGFR and longer duration of illness were found to be the contributing factors for the development of anaemia in DM patients. Therefore, by considering the negative impact of anaemia, it is important to include anaemia screening into routine assessment of DM‐related complications targeting patients with older age, poor glycemic control, low eGFR, and longer duration of illness to reduce the magnitude of the problem.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology School of Biomedical and Laboratory Sciences College of Medicine and Health Sciences University of Gondar Gondar Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology School of Biomedical and Laboratory Sciences College of Medicine and Health Sciences University of Gondar Gondar Ethiopia
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Prevalence of Anaemia and Its Associated Factors among Type 2 Diabetes Mellitus Patients in University of Gondar Comprehensive Specialized Hospital. Anemia 2021; 2021:6627979. [PMID: 33628496 PMCID: PMC7889375 DOI: 10.1155/2021/6627979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Anaemia is one of the commonest blood disorders seen in patients with diabetes. In Ethiopia, chronic illnesses are tremendously raising with their complications. But very little research has been conducted, particularly on anaemia among diabetes mellitus (DM) patients. Therefore, this study aimed at assessing the prevalence of anaemia and associated factors among type 2 diabetes mellitus patients in Northwest Ethiopia. Methods A cross-sectional study design was employed at University of Gondar Comprehensive Specialized Hospital from March 1 to April 15, 2019, among 372 type 2 diabetes mellitus patients (T2DM). Multivariable logistic regression analysis was fitted, and the corresponding adjusted odds ratio (AOR) and 95% CI were used to identify factors associated with anaemia. Level of significance was declared at the p value less than 0.05. Results The study revealed 8.06% (95% CI: 5.68-11.31%) of the participants were anaemic. Being male (AOR = 2.74, CI: 1.02, 7.38), combined type of treatment (AOR = 8.38, CI: 1.66, 42.25), having diabetes-related microvascular complications (AOR = 3.24, CI: 1.14, 9.26), and hypertension (AOR = 0.01, CI: 0.002, 0.06) were the significant factors associated with anaemia. Conclusions The finding of the current study revealed low prevalence of anaemia among T2DM patients. Sex, type of treatment, diabetes-related microvascular complications, and hypertension were factors associated with anaemia. Assessment of haemoglobin levels among T2DM patients may help to prevent ensuing microvascular complications. Incorporate anaemia screening into the routine assessment of diabetic complication particularly for those who are hypertensive and took combined treatment to allow early appreciation and treatment of anaemia and later improve the overall care of patients with diabetes.
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Tujuba T, Ayele BH, Fage SG, Weldegebreal F. Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study. Diabetes Metab Syndr Obes 2021; 14:467-476. [PMID: 33564253 PMCID: PMC7866907 DOI: 10.2147/dmso.s289298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although anemia is a common condition among patients with diabetes mellitus, there is little evidence on anemia among this segment of population in Ethiopia at large and in the study setting in particular. Thus, this study aimed at assessing the magnitude of anemia and its associated factors among adult diabetic patients attending a general hospital in Eastern Ethiopia. METHODS A health facility-based cross-sectional study was conducted among 325 randomly selected adult diabetes mellitus patients attending a follow-up clinic at Gelemso General Hospital, Eastern Ethiopia. Data were collected through an interview using a pre-tested and structured questionnaire followed by physical and laboratory measurements. Data were then entered into EpiData Version.3.1 and analyzed by using STATA version 16.0. Binary logistic regression models were fitted to identify factors associated with anemia. All statistical tests were declared significant at p-value < 0.05. RESULTS The magnitude of anemia among adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Anemia was higher in males (36%) than females (20.5%). Male gender (Adjusted Odds Ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM duration of ≥5 years (AOR= 1.9, 95% CI: 1.0, 3.7), presence of comorbidity (AOR= 1.9, 95% CI: 1.0, 3.7), and having diabetic complications (AOR= 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia. CONCLUSION Anemia was a moderate public health problem among adult DM patients in the study setting. Being male in gender, duration of DM, presence of DM complications, and DM co-morbidities were factors associated with anemia. Therefore, routine screening and appropriate management of anemia targeting males, DM patients with longer duration of DM, and those with complications and co-morbidities should be devised to improve patients' quality of life. Early diagnosis and regular monitoring of DM could also help to minimize further complications.
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Affiliation(s)
- Teshome Tujuba
- Department of Medical Laboratory, Gelemso General Hospital, Gelemso, Ethiopia
| | - Behailu Hawulte Ayele
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Sagni Girma Fage College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia Email
| | - Fitsum Weldegebreal
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Adane T, Getaneh Z, Asrie F. Red Blood Cell Parameters and Their Correlation with Renal Function Tests Among Diabetes Mellitus Patients: A Comparative Cross-Sectional Study. Diabetes Metab Syndr Obes 2020; 13:3937-3946. [PMID: 33122930 PMCID: PMC7591059 DOI: 10.2147/dmso.s275392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) patients show a significant derangement in various hematological parameters including changes affecting the red blood cells (RBCs). All these derangements have an imposing effect on any of the RBC indices. Thus, the main aim of this study was determining the RBCs parameters and their correlation with renal function, and also the magnitude of anemia in DM patients in comparison with healthy controls. METHODS A comparative cross-sectional study was conducted at the chronic illness clinic of University of Gondar Hospital from January to April 2020. A total of 246 participants (164 DM and 82 controls) were selected using a simple random sampling technique. Data were collected using a pretested structured questionnaire. Five milliliters venous blood was collected by vacutainer blood collection technique. RBC parameters and renal function tests were determined by using Sysmex KX21N and BS-200E Mindray analyzers, respectively. The data were tested for normality using Shapiro-Wilk and Kolmogorov-Smirnov tests. Independent sample t-test and Pearson's and Spearman correlation statistics were used to analyze variables. A p-value ˂0.05 was considered as statistically significant. RESULTS The mean hemoglobin (Hgb) concentration was 13.8±0.7 and 15±1.3 among DM and controls, respectively. RBC (p=0.014), Hgb (p ˂0.001), hematocrit (Hct) (p ˂0.001), and mean cell volume (MCV) (p ˂0.001) were significantly lower in DM patients as compared to controls. On the other hand, mean cell hemoglobin concentration (MCHC) was significantly increased in DM patients (p ˂0.001) than the controls. Besides, a significant negative correlation was found between Hgb and creatinine (Cr) in DM patients. CONCLUSION The mean values of RBC parameters (RBC, Hgb, Hct, and MCV) for DM patients were found significantly lower than the control groups. Besides a significant negative correlation was found between Cr and RBC indices (RBC, Hgb, Hct, and MCV) in DM patients. It is, therefore, suggested that RBC parameters abnormalities should be evaluated and treated periodically in DM patients for better prognosis and quality of life.
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Affiliation(s)
- Tiruneh Adane
- School of Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zegeye Getaneh
- School of Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fikir Asrie
- School of Biomedical and Laboratory Sciences, Department of Hematology and Immunohematology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Engidaw MT, Feyisa MS. Prevalence of Anemia and Its Associated Factors Among Adult Diabetes Mellitus Patients at Debre Tabor General Hospital, Northcentral Ethiopia. Diabetes Metab Syndr Obes 2020; 13:5017-5023. [PMID: 33376371 PMCID: PMC7755378 DOI: 10.2147/dmso.s286365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/02/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a cluster of metabolic disorders which is characterized by hyperglycemia. The occurrence of anaemia is a significant public health problem among diabetic patients because of complication and dietary modifications. So, this study aimed to assess the magnitude of anaemia among adult diabetes mellitus patients in Debre Tabor General Hospital, Ethiopia. METHODS A cross-sectional study design was conducted. A simple random sampling technique was employed to collect data from 297 adult diabetic mellitus patients. After taking venous blood, the haemoglobin level was determined by using HemoCue 301 machine. Anaemia among diabetic patients was determined by using the haemoglobin level (<13.0g/dL for male and <12.0g/dL for female). Data were entered using EpiInfo version 7.2 and analyzed using SPSS version 21. The binary logistic regression model was used to explore the association of independent variables with anaemia. Finally, p-value <0.05 was used to declare the level of statistical significance. RESULTS The prevalence of anemia among diabetic patient was 29.81% (95% CI: 24.27, 35.35). Diabetic patients unable to read and write (AOR = 3.51, 95% CI: 1.40, 8.75), able to read and write (AOR = 9.76, 95% CI: 3.15, 30.24), ≥4 family size (AOR = 0.53, 95% CI: 0.29, 0.99), intake of flesh meat (AOR=0.19, 95% CI: 0.05, 0.74), and parasitic infections (AOR = 0.26, 95% CI: 0.07, 0.95) were more likely to develop anemia. CONCLUSION Anemia is a moderate public health problem among diabetic patients. Here, educational status, family size, intake of flesh meat, and intestinal parasite infections were the factors associated with the development of anaemia. So, working on these significant factors by health care providers during routine care is vital to prevent anaemia among diabetic patients.
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Affiliation(s)
- Melaku Tadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Melaku Tadege Engidaw Department of Public Health, College of Health Sciences, Debre Tabor University, P.O. Box: 031, Debre Tabor, Ethiopia Email
| | - Mahider Shimelis Feyisa
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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