Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population

Abstract

Diabetes mellitus (DM) and also anemia are common in the elderly and have a negative impact on the clinical outcomes of patients. The coexistence of anemia and DM seems to be insufficiently recognized; therefore, the aim of our study is to analyze the incidence and clinical consequences of this coexistence, including mortality, in the population of people aged ≥60. A retrospective study was conducted on 981 primary care clinic patients aged ≥60 during 2013-2014. The prevalence of coexistence of DM and anemia (defined in accordance with WHO) and data on the incidence of comorbidities, hospitalization, medical procedures, and all-cause mortality were analyzed. In the study population, 25% had DM, while 5.4% had both DM and anemia. Peripheral artery disease (PAD) was found in 48 patients (4.89%) of the entire study population, more often in men ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>p</a:mi><a:mo>&lt;</a:mo><a:mn>0.001</a:mn></a:math> ). Diabetic patients with anemia compared to nonanemic diabetics had more comorbidities (median 4 (4, 5) vs. 3 (2–4); <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>p</c:mi><c:mo>&lt;</c:mo><c:mn>0.001</c:mn></c:math> )—PAD more often ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"><e:mi>p</e:mi><e:mo>=</e:mo><e:mn>0.004</e:mn></e:math> ), more hospitalization (median 2 (0–11) vs. 0 (0–11); <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"><g:mi>p</g:mi><g:mo>&lt;</g:mo><g:mn>0.001</g:mn></g:math> ), and more frequent medical procedures (e.g., percutaneous coronary intervention ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"><i:mi>p</i:mi><i:mo>&lt;</i:mo><i:mn>0.001</i:mn></i:math> ), coronary artery bypass surgery ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"><k:mi>p</k:mi><k:mo>=</k:mo><k:mn>0.027</k:mn></k:math> ), arteriography ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"><m:mi>p</m:mi><m:mo>&lt;</m:mo><m:mn>0.001</m:mn></m:math> ), and bypass surgery or endovascular treatments of lower limb ischemia ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"><o:mi>p</o:mi><o:mo>&lt;</o:mo><o:mn>0.001</o:mn></o:math> )). The cumulative survival of patients with both DM and anemia vs. nonanemic diabetics at 36 months was 86.4% vs. 99.3% ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"><q:mi>p</q:mi><q:mo>&lt;</q:mo><q:mn>0.001</q:mn></q:math> ). A multivariate logistic regression model showed anemia to be a significant risk factor for death in diabetic patients ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"><s:mi>p</s:mi><s:mo>=</s:mo><s:mn>0.013</s:mn></s:math> ). Patients with both DM and anemia have more comorbidities than nonanemic diabetic patients; they are more often hospitalized, require medical procedures more frequently, and are at a higher risk of death. Effective treatment of anemia in patients with DM is advisable and may well improve the prognosis of patients.