Morphological Classification, Associated Factors and Prevalence of Anaemia in Type 2 Diabetes Mellitus Patients at Fort Portal Regional Referral Hospital, Western Uganda
Purpose: To determine the morphological classification, associated factors and prevalence of anaemia among T2DM patients at Fort Portal Regional Referral Hospital, Southwestern Uganda. Methods: This cross-sectional study enrolled 230 T2DM patients, 60 (26.1%) males and 170 (73.9%) females. The socio-demographic characteristics were collected using structured questionnaires, 4ml of venous blood was collected from each study participant into an EDTA vacutainer. The random blood sugar level of each participant was measured using a OneTouch glucometer and recorded. The blood samples were then transported to the central laboratory for Complete Blood Counts using a SYSMEX XN 550 haematology analyser. Thin smears were made for participants who had low Hb (<12.0 g/dl for females and <13.0 g/dl for males) according to the WHO definition of anaemia. The thin films were fixed with absolute methanol and stained using May-Grunwald Giemsa stain then dried and examined for the morphological types of anaemia using ×1000 magnification. Results: The overall prevalence of anaemia in T2DM in this study was 8.3%. Anaemia was equally distributed among males and females (8.3% and 8.2% respectively). As far as morphological types of anaemia are concerned, normocytic normochromic anaemia was more prevalent, 12 (63.2%) followed by normocytic hypochromic, 3 (15.8%), microcytic normochromic, 2 (10.5%) and microcytic hypochromic, 2 (10.5%). The factors which were associated with anaemia were level of education (AOR 4.2, p-value 0.174) and age 50 years and above (AOR: 1.2, p-value 0.712). However, they were not statistically significant; p-value > 0.05. Conclusion: The prevalence of anaemia in T2DM in this study was low compared to other studies done within the country. Normocytic normochromic was the commonest type of anaemia and low level of education and age 50 years and above were associated with anaemia.
References
[1]
Idris, I., Tohid, H., Muhammad, N.A., A Rashid, M.R., Mohd Ahad, A., Ali, N., et al. (2018) Anaemia among Primary Care Patients with Type 2 Diabetes Mellitus (T2DM) and Chronic Kidney Disease (CKD): A Multicentred Cross-Sectional Study. BMJ Open, 8, e025125. https://doi.org/10.1136/bmjopen-2018-025125
[2]
Bongomin, F., Olum, R., Kyazze, A.P., Ninsiima, S., Nattabi, G., Nakyagaba, L., et al. (2021) Anemia in Ugandan Pregnant Women: A Cross-Sectional, Systematic Review and Me-ta-Analysis Study. Tropical Medicine and Health, 49, Article No. 19. https://doi.org/10.1186/s41182-021-00309-z
[3]
Taderegew, M.M., Ge-bremariam, T., Tareke, A.A. and Woldeamanuel, G.G. (2020) anemia and Its Associated Factors among Type 2 Diabetes Mellitus Patients Attending Debre Berhan Referral Hospital, North-East Ethiopia: A Cross-Sectional Study. Journal of Blood Medicine, 11, 47-58. https://doi.org/10.2147/jbm.s243234
[4]
Tujuba, T., Ayele, B.H., Fage, S.G. and Weldegebreal, F. (2021) Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: A Cross-Sectional Study. Diabetes, Meta-bolic Syndrome and Obesity: Targets and Therapy, 14, 467-476. https://doi.org/10.2147/dmso.s289298
[5]
Alalawi, B., Bukari, S., Al-Alawi, Y., Alraheili, R., Alharbi, R., Alraheili, A., et al. (2021) Prevalence and Predictors of Anemia among Type 2 Diabetic Patients, Single Center Study in Al-Madinah Region, Saudi Arabia.
[6]
Kebede, S.A., Tusa, B.S. and Weldesenbet, A.B. (2021) Prevalence of Anaemia and Its Associated Factors among Type 2 Diabe-tes Mellitus Patients in University of Gondar Comprehensive Specialized Hospi-tal. Anemia, 2021, Article ID: 6627979. https://doi.org/10.1155/2021/6627979
[7]
Ahmad, E., Lim, S., Lamptey, R., Webb, D.R. and Davies, M.J. (2022) Type 2 Diabetes. The Lancet, 400, 1803-1820. https://doi.org/10.1016/s0140-6736(22)01655-5
[8]
Kotwas, A., Karakiewicz, B., Zabielska, P., Wieder-Huszla, S. and Jurczak, A. (2021) Epi-demiological Factors for Type 2 Diabetes Mellitus: Evidence from the Global Burden of Disease. Archives of Public Health, 79, Article No. 110. https://doi.org/10.1186/s13690-021-00632-1
[9]
Cho, N.H., Shaw, J.E., Karuranga, S., Huang, Y., da Rocha Fernandes, J.D., Ohlrogge, A.W., et al. (2018) IDF Diabetes Atlas: Global Estimates of Diabetes Prevalence for 2017 and Projections for 2045. Diabetes Research and Clinical Practice, 138, 271-281. https://doi.org/10.1016/j.diabres.2018.02.023
[10]
Cole, J.B. and Florez, J.C. (2020) Genetics of Diabetes Mellitus and Diabetes Complications. Nature Re-views Nephrology, 16, 377-390. https://doi.org/10.1038/s41581-020-0278-5
[11]
Bonner, R., Albajrami, O., Hudspeth, J. and Upadhyay, A. (2020) Diabetic Kidney Disease. Primary Care: Clinics in Office Practice, 47, 645-659. https://doi.org/10.1016/j.pop.2020.08.004
[12]
Faivre, A. and de Seigneux, S. (2021) Haemoglobin as a Marker of Fibrosis in Early Diabetic Kidney Disease. Nephrology Dialysis Transplantation, 37, 403-404. https://doi.org/10.1093/ndt/gfab217
[13]
Portolés, J., Martín, L., Broseta, J.J. and Cases, A. (2021) Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Frontiers in Medicine, 8, Article ID: 642296. https://doi.org/10.3389/fmed.2021.642296
[14]
Fishbane, S. and Spinowitz, B. (2018) Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018. American Journal of Kidney Diseases, 71, 423-435. https://doi.org/10.1053/j.ajkd.2017.09.026
[15]
Cernaro, V., Coppolino, G., Visconti, L., Rivoli, L., Lacquaniti, A., Santoro, D., et al. (2018) Erythropoiesis and Chronic Kidney Disease–related Anemia: From Physiology to New Thera-peutic Advancements. Medicinal Research Reviews, 39, 427-460. https://doi.org/10.1002/med.21527
[16]
Tsai, S. and Tarng, D. (2019) Anemia in Patients of Diabetic Kidney Disease. Journal of the Chinese Medical Association, 82, 752-755. https://doi.org/10.1097/jcma.0000000000000175
[17]
Zulhendri, F., Ravalia, M., Kripal, K., Chandrasekaran, K., Fearnley, J. and Perera, C.O. (2021) Propolis in Metabolic Syndrome and Its Associated Chronic Diseases: A Narra-tive Review. Antioxidants, 10, Article No. 348. https://doi.org/10.3390/antiox10030348
[18]
Mariana, M.D. (2023) Altera-tion of Some Red Blood Cell Components in Diabetes Mellitus. Editorial Board. 17.
[19]
Abdel-Moneim, A., Abdel-Reheim, E.S., Semmler, M. and Addaleel, W. (2019) The Impact of Glycemic Status and Metformin Administration on Red Blood Cell Indices and Oxidative Stress in Type 2 Diabetic Patients. Malaysian Journal of Medical Sciences, 26, 47-60. https://doi.org/10.21315/mjms2019.26.4.6
[20]
Elliott, J. (2023) Therapeu-tics of Managing Reduced Red Cell Mass Associated with Chronic Kidney Dis-ease—Is There a Case for Earlier Intervention? Journal of Veterinary Pharma-cology and Therapeutics, 46, 145-157. https://doi.org/10.1111/jvp.13127
[21]
Bekele, A., Teji Roba, K., Egata, G. and Gebremichael, B. (2019) Anemia and Associated Factors among Type-2 Diabetes Mellitus Patients Attending Public Hospitals in Harari Region, Eastern Ethiopia. PLOS ONE, 14, e0225725. https://doi.org/10.1371/journal.pone.0225725
[22]
Ahmed, K., Danial, K., Khurram, A., Wasey, M.A., Jangda, M.A. and Ali, Z. (2017) To Evaluate the Re-nal Function Deterioration Along with Other Anemia Predictors in Patients with Diabetes Mellitus Type 2 in Karachi, Pakistan. Pakistan Journal of Surgery, 33, 135.
[23]
AlDallal, S.M. and Jena, N. (2018) Prevalence of Anemia in Type 2 Diabetic Patients. Journal of Hematology, 7, 57-61. https://doi.org/10.14740/jh411w
[24]
Trevest, K., Treadway, H., der Cingel, G.H., Bailey, C. and Abdelhafiz, A.H. (2014) Prevalence and Determinants of Anemia in Older People with Diabetes Attending an Outpatient Clinic: A Cross-Sectional Audit. Clinical Diabetes, 32, 158-162. https://doi.org/10.2337/diaclin.32.4.158
[25]
Panda, A. and Ambade, R. (2018) Prevalence of Anemia and Its Correlation with HBA1c of Patients in Type-II Diabetes Mellitus: A Pilot Study. National Journal of Physiology, Pharma-cy and Pharmacology, 8, 1409-1413. https://doi.org/10.5455/njppp.2018.8.0621511072018
[26]
Feteh, V.F., Choukem, S., Kengne, A., Nebongo, D.N. and Ngowe-Ngowe, M. (2016) Anemia in Type 2 Diabetic Patients and Correlation with Kidney Function in a Tertiary Care Sub-Saharan African Hospital: A Cross-Sectional Study. BMC Nephrology, 17, Article No. 29. https://doi.org/10.1186/s12882-016-0247-1
[27]
Abate, A., Birhan, W. and Alemu, A. (2013) Association of Anemia and Renal Function Test among Diabetes Mellitus Patients Attending Fenote Selam Hospital, West Gojam, Northwest Ethiopia: A Cross Sectional Study. BMC Blood Disorders, 13, Article No. 6. https://doi.org/10.1186/2052-1839-13-6
[28]
Patrick, N.B., Yadesa, T.M., Muhindo, R. and Lutoti, S. (2021) Poor Glycemic Control and the Contributing Factors among Type 2 Diabetes Mellitus Patients Attending Outpa-tient Diabetes Clinic at Mbarara Regional Referral Hospital, Uganda. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14, 3123-3130. https://doi.org/10.2147/dmso.s321310
[29]
Asiimwe, D., Mauti, G.O. and Kiconco, R. (2020) Prevalence and Risk Factors Associated with Type 2 Diabetes in Elderly Patients Aged 45-80 Years at Kanungu District. Journal of Diabetes Research, 2020, Article ID: 5152146. https://doi.org/10.1155/2020/5152146
[30]
Akabwai, G.P., Kibirige, D., Mugenyi, L., Kaddu, M., Opio, C., Lalitha, R., et al. (2015) Vitamin B12 Defi-ciency among Adult Diabetic Patients in Uganda: Relation to Glycaemic Control and Haemoglobin Concentration. Journal of Diabetes & Metabolic Disorders, 15, Article No. 26. https://doi.org/10.1186/s40200-016-0250-x
[31]
Shams, N. and Osmani, M.H. (2015) Newly Diagnosed Anemia in Admitted Diabetics, Frequency, Etiology and Associated Factors. Journal of College of Physicians and Surgeons Pakistan, 25, 242-246.
[32]
Hizomi Arani, R., Fakhri, F., Naeimi Tabi-ee, M., Talebi, F., Talebi, Z., Rashidi, N., et al. (2023) Prevalence of Anemia and Its Associated Factors among Patients with Type 2 Diabetes Mellitus in a Refer-ral Diabetic Clinic in the North of Iran. BMC Endocrine Disorders, 23, Article No. 58. https://doi.org/10.1186/s12902-023-01306-5
[33]
Awofisoye, O., Ade-leye, J., Olaniyi, J. and Esan, A. (2019) Prevalence and Correlates of Anemia in Type 2 Diabetes Mellitus: A Study of a Nigerian Outpatient Diabetic Population. Sahel Medical Journal, 22, 55-63. https://doi.org/10.4103/smj.smj_65_18
[34]
Mohamedahmed, K.A., Moham-med, R.M. and Talha, A.A. (2022) Prevalence of Anemia among Patients with Type II Diabetes Mellitus, Alkhair Medical Center, Wad Medani, Gezira State, Sudan (2020). International Journal of Healthcare and Medical Sciences, 8, 13-18. https://doi.org/10.32861/ijhms.83.13.18
[35]
Al-Ghazaly, J., Atef, Z. and Al-Dubai, W. (2019) Pattern and Causes of Anemia in Yemeni Patients with Type 2 Diabetes Mellitus. European Journal of Biomedical and Pharmaceuti-cal Sciences, 6, 66-74.
[36]
Rathod, G.B., Parmar, P., Rathod, S. and Parikh, A. (2016) Prevalence of Anemia in Patients with Type 2 Diabetes Mellitus at Gandhinagar, Gujarat, India. International Archives of Integrated Medicine, 3, 12-16.
[37]
Gizem Yilmaz, H.S. (2023) Normochromic Normocytic Anemia. American Society of Haemotology, 1-7.
[38]
Kaushik, D., Parashar, R. and Ma-lik, P.K. (2018) Study of Anaemia in Type 2 Diabetes Mellitus. International Journal of Research in Medical Sciences, 6, 1529-1533. https://doi.org/10.18203/2320-6012.ijrms20181428
[39]
Shaheen, E. (2019) Prevalence of Anemia in Patients with Type 2 Diabetes. Journal of Medi-cine in Scientific Research, 2, Article No. 3. https://doi.org/10.4103/jmisr.jmisr_29_19
[40]
Chaudhry, H.S. and Kasarla, M.R. (2017) Microcytic Hypochromic Anemia.
[41]
Mantadakis, E., Chatzimi-chael, E. and Zikidou, P. (2020) Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Ther-apy. Mediterranean Journal of Hematology and Infectious Diseases, 12, e2020041. https://doi.org/10.4084/mjhid.2020.041
[42]
Engidaw, M.T. and Feyisa, M.S. (2020) Prevalence of Anemia and Its Associated Factors among Adult Diabetes Mellitus Patients at Debre Tabor General Hospital, Northcentral Ethiopia. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 5017-5023. https://doi.org/10.2147/dmso.s286365
[43]
Fiseha, T. and Be-lete, A.G. (2019) Diabetes Mellitus and Its Associated Factors among Human Immunodeficiency Virus-Infected Patients on Anti-Retroviral Therapy in Northeast Ethiopia. BMC Research Notes, 12, Article No. 372. https://doi.org/10.1186/s13104-019-4402-1
