Anemia and Its Associated Factors Among Type 2 Diabetes Mellitus Patients Attending Debre Berhan Referral Hospital, North-East Ethiopia: A Cross-Sectional Study

Abstract

Purpose

Anemia is one of the common complications of diabetes mellitus (DM), which has an adverse effect on the progression and development of other diabetes-related complications. In spite of this, relatively little information is available on the prevalence of anemia and associated factors among type 2 diabetes mellitus (T2DM) patients in Ethiopia, particularly in the study area. Thus, this study assessed the prevalence of anemia and associated factors among T2DM patients at Debre Berhan Referral Hospital (DBRH), North-East, Ethiopia.

Patients and Methods

A hospital-based cross-sectional study was conducted from April 1 to May 30, 2019, among 249 T2DM patients with follow up at DBRH, selected using a systematic random sampling technique. Data were collected by face-to-face interviews, anthropometric measurements, and laboratory tests; such as hemoglobin measurements, red blood indices, and serum creatinine analysis. The data were coded and entered into Epi-data manager version 4.4.1.0, and analysis by using SPSS version 22 was carried out. To identify the determinant factors of anemia, bivariate and multivariate logistic regression analyses were performed. P-value <0.05 was considered as statistically significant.

Results

The study showed 20.1% of the participants were anemic. Being age >60 years (AOR=3.06, 95% CI: 1.32–7.11), poor glycemic control (AOR=2.95, 95% CI: 1.22–7.15), eGFR 60–89.9 mL/min/1.73m² (AOR=2.91, 95% CI: 1.15–7.37), eGFR <60 mL/min/1.73m² (AOR=6.58, 95% CI: 2.42–17.93), DM duration >10 years (AOR= AOR=2.75, 95% CI: 1.17–6.48), and having diabetic complications (AOR=3.81, 95% CI: 1.65–8.81) were significantly associated with anemia.

Conclusion

One out of five T2DM patients had anemia. Poor glycemic control, decreased eGFR, presence of DM complications, duration of DM >10 years, and age >60 years were significantly associated with the occurrence of anemia among T2DM. Regular screening for anemia in all T2DM patients may help in the early detection and management of anemia.

Keywords:

• type 2 DM
• anemia
• associated factors
• Ethiopia

Acknowledgments

The authors would like to extend their deepest appreciation to all staff member of Diabetic clinic of Debre Berhan Referral Hospital for their collaboration to providing the necessary information for this study. We also would like to thank all the study participants for their cooperation during the study. We are grateful to thank Jimma University for providing financial assistance for the study.

Abbreviations

AGEs, Advanced Glycation End Products; AOR, Adjusted Odd Ratio; BMI, Body Mass Index; CI, Confidence Interval; CKD, Chronic Kidney Disease; CLD, Chronic Liver Disease; DBP, Diastolic Blood Pressure; DBRH, Debre Berhan Referral Hospital; DL, Deciliters; DM, Diabetes Mellitus; EDTA, Ethylene Diamine Tetra Acetic Acid; eGFR, Estimated Glomerular Filtration Rate; FBG, Fasting Blood Glucose; FL, Femto Liter; Hb, Hemoglobin; IDF, International Diabetic Federation; MCH, Mean Corpuscular Hemoglobin; MCHC, Mean Corpuscular Hemoglobin Concentration; MCV, Mean Corpuscular Volume; MDRD, Modification of Diet in Renal Disease; OR, Odds Ratio; PG, Pico Gram; RBC, Red Blood Cell; RPM, Revolution Per Minute; SBP, Systolic Blood Pressure; SCr, Serum Creatinine; SD, Standard Deviation; SPSS, Statistical Package for Social Science; WHO, World Health Organization.

Ethics Approval and Informed Consent

The study was undertaken after the Institutional Review Board (IRB) of the institute of Health, Jimma University, approved the study protocol. Then Permission and supportive letter to carry out the study was also obtained from Debre Berhan Referral Hospital. The study was conducted in accordance with the Declaration of Helsinki, and an informed consent (verbal as well as written) was obtained from each study participants. Confidentiality was maintained by omitting their name; rather the patient’s card number was used as patient unique identification number throughout the study and unauthorized persons did not have access to the data. Those patients with anemia, renal insufficiency, and other relevant findings; were linked to physician for proper management.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This study was funded by Jimma University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.