Prevalence and risk factors of anemia in type 2 diabetic patients hospitalized at the 199 hospital

PREVALENCE AND RISK FACTORS OF ANEMIA IN TYPE 2 DIABETIC PATIENTS HOSPITALIZED AT THE 199 HOSPITAL

Huynh Le Thai Bao*, Quach Huu Trung**

*Duy Tan University; **199 Hospital

DOI: 10.47122/vjde.2022.53.2

ABSTRACT

Objective: Determination of anemia rate in patients with type 2 diabetes treated at hospital 199 Ministry of Public Security in 2021. Understanding some factors related to anemia in patients with type 2 diabetes treated at hospital 199 Ministry of Public Security in 2021. Methodology: A descriptive cross-sectional study, 232 patients patients diagnosed with type 2 diabetes outpatient treatment at 199 hospital from January 2021 to June 2021. Results:  Anemia accounted for 52.6%. Isochromic, isochromic anemia accounted for the majority with 88.3%; hypochromic anemia, small red blood cells account for 9.9%; The lowest is megaloblastic anemia accounting for very little with 1.8%. Regarding the co-morbidities of patients with type 2 diabetes, dyslipidemia accounted for 61.2%, hypertension rate 51.7%, chronic kidney disease rate 28.4%. The state of blood glucose control is not good when uncontrolled diabetes accounts for 55.6%. Accordingly, only co-morbidities such as hypertension and chronic kidney disease increase the rate of anemia in diabetic patients and have statistical significance. Conclusion: Need to pay more attention and attention to anemia in patients with type 2 diabetes in Vietnam

Keywords: Anemia, diabetes, related factors

Main correspondence: Huynh Le Thai Bao

Submission date: 19th Oct 2022

Revised date: 19th Nov 2022

Acceptance date: 19th Dec 2022

Email: [email protected], [email protected]

Tel: 0966929391

 

1. BACKGROUND

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia, causing damage to many different organs, especially the heart, blood vessels, kidneys, eyes, and nerves. The disease tends to increase with economic development and sedentary lifestyle, inappropriate nutrition [7], [18].

Anemia is one of the common blood disorders in patients with type 2 diabetes and itself exacerbates the complications of this disease. However, clinically this condition is often “forgotten”. That greatly affects the treatment and health care of patients [26]. In the world, there have been a number of authors studying anemia in patients with type 2 diabetes. The obtained results show that the rate of anemia in patients with type 2 diabetes has large differences between countries [15] ]. Studies show that: 41.4% in Cameroon, 39.4% in Malaysia, 18% in India, 55.5% in Saudi, and 34.8% in Ethiopia… [13]. In China, this rate is 30.4%. There have been a few studies addressing this issue, such as Kebede’s study with significant factors such as gender, treatment modality, microvascular complications, and possible microvascular complications. associated with diabetes [18].

Da Nang is a central city in the South Central Coast region. In recent years, the city has attracted great investment from businesses and secondary investors, so it also attracts residents from many regions to work and settle here. Along with industrial life, a number of diseases are also at an increased risk due to a busy lifestyle, less physical activity, eating fast food, thus increasing the risk of chronic diseases, cardiovascular diseases, internal diseases. Excretion is inevitable, including diabetes. In Vietnam, there have been many studies on the prevalence of diabetes in the country, but up to now, there has been no study on the rate of anemia in patients with type 2 diabetes and some other factors. relate to. Stemming from the above bases, we conducted the topic “The rate of anemia and some related factors in patients with type 2 diabetes treated at 199 hospital of the Ministry of Public Security in 2021” with the hope contribute to reducing the burden caused by non-communicable diseases in general and diabetes in particular in Da Nang.

Objectives of the study: Determination of anemia rate in patients with type 2 diabetes treated at hospital 199 Ministry of Public Security in 2021. Understanding some factors related to anemia in patients with type 2 diabetes treated at hospital 199 Ministry of Public Security in 2021.

2. METHODS

2.1. Research subjects:

All patients diagnosed with type 2 diabetes outpatient treatment at 199 hospital of the Ministry of Public Security from January 2021 to June 2021.

2.2. Study time and place:

2.2.1. Study time: from January 2021 to June 2021.

2.2.2. Research location: 199 Hospital

2.3. Research design: Descriptive cross-sectional study

2.4. Sample Size:

The study sample size was calculated according to the formula for determining a proportion in a population:

In which:

+ n: Research sample size

+ Z: value of normal distribution, with 95% confidence interval, then Z_((1-∝/2)) = 1.96

+ a: probability of type I error, with = 0.05 + p = 0.65: is the rate of anemia in diabetic patients taken from the previous study of ES-Saied Shaheen.

+ ε is the relative error, choose ε = 0.1. Substituting into the formula we can calculate n ≈ 207 patients. In order to prevent about 10% of cases where patients refuse to continue to participate or lack information of research subjects for some reason, the actual sample size needed is: 207 + 20,701 = 227, actually. We selected 232 patients into the study sample.

3. RESULTS

3.1. General characteristics of the study sample

Table 3.1. Distribution of study sample by background variable (n = 232)

Comment: Among 232 patients in the study sample, female patients accounted for a higher proportion with 53.9%. The average age of the study sample was 55.2 ± 16.8 years old, with the highest age group being < 50 years old.

Table 3.2. Distribution of study samples according to some comorbidities

Comment: The highest rate of comorbidities in the study sample was dyslipidemia with 61.2%, followed by hypertension with 51.7%. Besides, the rate of chronic kidney disease is also quite significant with 28.4%.

Table 3.3. Characteristics of blood glucose control status of the study sample

Comments: The study sample had blood glucose indexes: Fasting glucose was 8.0 ± 4.5 mmol/l and HbA1c concentration was 7.6 ± 2.5%. The rate of uncontrolled diabetes was 55.6%.

Table 3.4. Distribution of hematological characteristics of the study sample

Comment: In general, the hematological indices of leukocytes and platelets of the patients in the study sample were quite similar to those of healthy adults. As for the erythrocyte index, the average index of red blood cell count is 4.4 ± 0.8 million/l and the hemoglobin index is 12.3 ± 2.4 g/l which are two lower indicators than the hemoglobin index. with healthy adults. Other indicators of red blood cells are quite similar to normal healthy people.

Chart 3.1. Prevalence of anemia in patients with type 2 diabetes

Comment: The rate of anemia in the study sample was 52.2%. Slightly higher than without anemia.

Table 3.5. Distribution of study samples according to anemia grade

Comments: Regarding the anemia grade of the study sample, most of them are grade 1 anemia, accounting for 35.8%, lower than grade 2 anemia with 10.8%, followed by grade 3 anemia with 5.6%, no patients with grade 4 anemia.

Table 3.6. Distribution of research samples according to anemia classification based on red blood cell characteristics

3.2.The relationship between some factors related to anemia in patients with type 2 diabetes

3.2.1.Association between anemia in patients with type 2 diabetes and some background variables

Table 3.7. Association betweenanemiain patients with type2 diabetes and some background variables

Comment: In the diabetic patients participating in the study, the rate of anemia in women was higher than in men, but the difference was not statistically significant. Similarly, there was no statistically significant difference between the age groups in the prevalence of anemia.

3.2.2. The relationship between anemia in type 2 diabetic patients with glycemic control

Bảng 3.8. The relationship between anemia in type 2 diabetic patients with glycemic control

Comments: There was no statistically significant difference in fasting blood glucose and HbA1c levels between the anemic and non-anemic groups in the study sample.

3.2.3. The relationship between anemia in patients with type 2 diabetes and some related factors

Table 3.9. Association between anemia in patients with type 2 diabetes and comorbidities

Comment: The rate of hypertension in the ischemic group was higher than that in the non-anemic group with a statistically significant difference, similar to the rate of anemia in the group with chronic kidney disease was higher than in the group without chronic kidney disease. difference is statistically significant. The group without dyslipidemia had a higher rate of anemia than the group without but the difference was not statistically significant.

4. DISCUSSION

4.1. General characteristics of the study sample

Among 232 patients with confirmed diagnosis of type 2 diabetes participating in the study, 125 were female, accounting for 53.9%, and 107 were male, accounting for 46.1%. Our results are quite similar to previous domestic and foreign studies when the proportion of women in the studies is often higher than that of men. The epidemiological study of diabetes in 2002 – 2012 by Phan Huong Duong also gave similar results to our study with the proportion of men accounting for 47.6% and women accounting for 52.4% of patients with diabetes in the community. copper.

Regarding age, the mean age of the study sample was 55.2 ± 16.8 years old. Recent studies on diabetes in hospitals across the country also have the average age of the research group quite similar to our study, such as the study of Nguyen Thi Bich Huyen (2021) with average age. average age is 55 years old, study by Tran Thi Tam (2020) with 53.8 ± 11 years old. This is consistent with community studies, where advanced age is a risk factor for diabetes.

Regarding the proportion of age groups, the age group with the highest proportion is under 40 years old with the rate of 31.9%, from 40-49 years old is 13.4%, from 50-59 years old is 28.9%, from 60 – 69 years old is 14.2%, ≥ 70 years old is 11.6%. This result is somewhat different from the community study of Phan Huong Duong (2016) when the age group under 40 has the lowest diabetes rate, then, every 5 years, the rate of diabetes in age groups increases.

The group with the highest rate of diabetes is the group over 60 years old. Perhaps, the reason for the above difference is because of our sample selection, when we select patients who are inpatient and outpatient treatment at Hospital 199 of the Ministry of Public Security, so there will be a difference. age group composition with a community-based study. In our opinion, in order to have an overall view and reflect more accurately, it is necessary to have a multi-center study conducted at many different hospitals to overcome errors caused by factors such as region, population, etc. again.

Regarding comorbidities in 232 patients with type 2 diabetes, dyslipidemia appeared in 142  patients, accounting for 61.2%, hypertension with 120 patients, accounting for 51.7%, kidney disease chronic in 66 patients, accounting for 28.4%. The rate of dyslipidemia in our study was lower than the study of Phan Huong Duong (2016) with 84.54%, the study of Tran Thi Tam (2020), Chau My Chi (2020) also showed the rate of dyslipidemia in our study. This is 83.9% and 78.38%, respectively [3]. Perhaps, because the age of diabetic patients in our study is lower than the above studies, the metabolic disorders leading to lipid disorders are less likely.

Also in Tran Thi Tam’s study (2020), the prevalence of hypertension accounted for 28.6% in diabetic patients (lower than our study – 51.7%), possibly due to the study. Tran Thi Tam’s study in just 1 month with a sample of 120 patients, this is likely to affect the data results and also does not rule out the impact of the COVID-19 epidemic on the research results.

Blood glucose control was not good when diabetes was uncontrolled in 129 patients, accounting for 55.6%; This rate is approximately the same as the study of Tran Thi Tam (2020) and Chau My Chi (2020) with good blood glucose control rate in the two studies respectively 57.1% and 56.76%. Meanwhile, the study of Salma M. (2018) gave a better blood glucose control rate than us with 68%. For controlled patients, the blood glucose at the time was 8.0 ± 4.5 and the HbA1c was 7.3 ± 1.6%.

These 2 values are close to the study of Tran Thi Tam (2020) and Chau My Chi (2020). In general, the blood glucose control in our study and other domestic studies has a high similarity, which also partly reflects the current status of diabetes treatment in Vietnam.

Hematological values in a relatively normal, healthy diabetic patient. Only red blood cell index, the average index of red blood cell count is 4.4 ± 0.8 million/l, Hemoglobin index is 12.3 ± 2.4 g/l; These two indicators are lower than that of healthy adults. Other indicators of red blood cells are quite similar to normal healthy people. Perhaps the rate of anemia in patients with diabetes is higher than in the community, so there is a difference, this will be discussed more clearly in the following section.

4.2. Prevalence of anemia and some factors related to diabetes patients

4.2.1. Prevalence of anemia in diabetic patients

The rate of anemia in patients with type 2 diabetes in our study was 52%, higher than that of Salma M. (2018) with 29.7% and equivalent to Vitalis F. Feteh (2016) with 41, 4%, With the results from our study and other studies, we hypothesize that the rate of anemia in patients with type 2 diabetes is higher than in those without type 2 diabetes [10], [15] ]. Indeed, Ishimura (1998) showed that the mean hemoglobin concentration in the group of patients with type 2 diabetes was significantly lower than in the group without type 2 diabetes [16]; Kazmi (2001) also conducted a cohort study to investigate the prevalence and risk factors of anemia in patients with type 2 diabetes, which showed that the prevalence of anemia increased with number of years. type 2 diabetes and is closely related to renal function and blood erythropoietin levels [17].

Regarding the anemia grade of the study sample, the majority of anemia was grade 1, accounting for 35.9%, lower than grade 2 anemia with 10.8%, followed by grade 3 anemia with 5.9%. , there were no patients with grade 4 anemia.

The rate of anemia in diabetic patients was 52.5%, much higher than the study of Sewnet Adem Kebede (2021) with 8.06%, Iran (30.4). %), Malaysia (39.4%) [18].

On the classification of anemia in patients with a confirmed diagnosis of anemia in the study blood; isochromic, isochromic anemia accounted for the majority with 88.3%; hypochromic anemia, small red blood cells account for 9.9%; The lowest is megaloblastic anemia accounting for very little with 1.8%.

4.2.2. The relationship between some factors related to anemia in diabetic patients

The study results showed that the rate of anemia in women was higher than in men, but this difference was not statistically significant (OR=1.6, p>0.05).

Similarly, there is no statistically significant difference between the age groups in the rate of anemia with p>0.05. Compared with the study of Sewnet Adem Kebede (2021), age is also not statistically significant (OR=1.23, p>0.05) but gender is more statistically significant for men than women (OR=1.69, p<0.05) ). It may be explained by genetic factors and the number of postmenopausal women due to the influence of menstruation on iron stores [22].

Regarding the status of blood glucose control, there was no statistically significant difference in fasting blood glucose concentration and HbA1c concentration between the anemic and non-anemic groups in the study sample. However, the group of patients with poor blood glucose control had a higher rate of anemia than the group with good blood glucose control (65.3% compared with 37.8%), the difference was statistically significant.

This result is similar to the study of Salma M. (2018) when the poor blood glucose control group had an anemia rate of 33.46% and the bad blood glucose control group was 27.9% with the difference. Statistical significance. Research by Vitalis F.Feteh (2016) also has similar results. In our opinion, good blood glucose control helps patients to be protected from complications of type 2 diabetes, in which these complications can be the “culprits” of anemia in patients with type 2 diabetes. 2. Indeed, the studies of Ishimura (1998) and Vitalis F. Feteh (2016) have shown that the poor blood glucose control group has worse kidney function than the good control group, thereby increasing the rate of deficiency. blood [10], [15].

When considering the relationship between co-morbidities, the rate of anemia was higher in the group with chronic kidney disease than in the group without CKD with a statistically significant difference (OR=2.1, p=0.012). The group without lipid disorders had a higher rate of anemia but it was not statistically significant (OR=0.6, p=0.1).

The above results are similar to the study of Salma M. and Vitalis F.Feteh (2016). It is easy to see that impaired kidney function in patients with type 2 diabetes is one of the causes leading to anemia, the studies of Ishimura (1998), Vitalis F. Feteh (2016) and Salma M. (2018) proved this. Besides, in the group without chronic kidney disease, 47.0% of patients still have anemia, which proves that besides the cause of impaired kidney function, patients with type 2 diabetes also have many other causes. Others lead to anemia. This may be explained by iron deficiency and systemic inflammation also contributing to the increased anemia in T2DM.

In addition, other causes such as the diet of T2DM patients, some drugs to treat type 2 diabetes have undesirable effects of causing gastrointestinal disturbances, reducing absorption, which can also be a factor in aggravating anemia.

Regarding hypertension, the results showed that the rate of anemia in the hypertensive group was higher than in the non-hypertensive group and this difference was statistically significant (OR=1.9, p=0.022). This association

was not different from the study of Kebede (2021) (p<0.001) [22]. It is easy to see that hypertension is also a consequence of impaired kidney function and a series of other complications, from which the rate of anemia in patients with type 2 diabetes is closely related to hypertension.

5. CONCLUSION

5.1. Characteristics of factors associated with type 2 diabetes:

Females are higher than males (53.9% compared with 46.1%), the age group under 40 accounts for the highest percentage (31.9%) with the mean age 55.2 ± 16.8 years old.

Anemia accounted for 52.6% (Anemia grade I: 25.9%, anemia grade II: 10.8%, anemia grade III: 5.9%).

Isochromic, isochromic anemia accounted for the majority with 88.3%; hypochromic anemia, small red blood cells account for 9.9%; The lowest is megaloblastic anemia accounting for very little with 1.8%.

Hematological values in a relatively normal, healthy diabetic patient.

Regarding the co-morbidities of patients with type 2 diabetes, dyslipidemia accounted for 61.2%, hypertension rate 51.7%, chronic kidney disease rate 28.4%.

The state of blood glucose control is not good when uncontrolled diabetes accounts for 55.6%.

5.2. The relationship between related factors and type 2 diabetes

Through the  multivariate survey, the relationship between the factors and anemia-diabetes was recorded.

Accordingly, only co-morbidities such as hypertension and chronic kidney disease increase the rate of anemia in diabetic patients and have statistical significance.

REFERENCES

1. Ministry of Health. (2020). Guidelines for the diagnosis and treatment of type 2 diabetes.
2. Ngo Quy Chau, Nguyen Lan Viet, Nguyen Dat Anh & Pham Quang Vinh. (2016). Internal Medicine, Volume 2. Medical Publishing House.
3. Chau My Chi, Nguyen Thi Minh Khuong & Tran Thi Hoa Van. (2020). Research on eye complications in diabetic patients at Tien Giang Central General Hospital. Journal of Diabetic Endocrinology, 46 (2021), 108-116.
4. Cho Ray Hospital. (2018). Treatment protocol 2018 section Internal medicine. Medical Publisher.
5. (2009). The International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care, 32(7), 1327-1334.
6. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928.
7. (2021). ADA’s Standards of Medical Care in Diabetes. Clin Diabetes, 39(1), 128.
8. (2021). Addendum. 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2021: Diabetes Care 2021;44(Suppl. 1):S151-S167. Diabetes Care, 44(9), 2186-2187.
9. Afkarian, M., Zelnick, L. R., Hall, Y. N., Heagerty, P. J., Tuttle, K., Weiss, N. S., et al. (2016). Clinical Manifestations of Kidney Disease Among US Adults With Diabetes, 1988-2014. JAMA, 316(6), 602-610.
10. 10. AlDallal, S. M. & Jena, N. (2018). Prevalence of Anemia in Type 2 Diabetic Patients. J Hematol, 7(2), 57-61.
11. American Diabetes Association. (2014). Diagnosis and Classification of Diabetes Mellitus. Diabetes Care,, 37(Supplement 1), S81-S90.
12. Angelousi, A. & Larger, E. (2015). Anaemia, a common but  often unrecognized risk in diabetic patients: a review. Diabetes Metab, 41(1), 18-27.
13. Bekele, A., Teji Roba, K., Egata, G. & Gebremichael, B. (2019). Anemia and associated factors among type-2 diabetes mellitus patients attending public hospitals in Harari Region, Eastern Ethiopia. PLoS One, 14(12), e0225725.
14. Buse, J. B., Ginsberg, H. N., Bakris, G. L., Clark, N. G., Costa, F., Eckel, R., et al. (2007). Primary prevention       of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the    American     Diabetes     Association. Diabetes Care, 30(1), 162-172.
15. Feteh, V. F., Choukem, S. P., Kengne, A. P., Nebongo, D. N. & 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 Nephrol, 17, 29.
16. Ishimura, E., Nishizawa, Y., Okuno, S., Matsumoto, N., Emoto, M., Inaba, M., et al. (1998). Diabetes mellitus increases the severity of anemia in non-dialyzed patients with renal failure. J Nephrol, 11(2), 83-86.
17. Kazmi, W. H., Kausz, A. T., Khan, S., Abichandani, R., Ruthazer, R., Obrador, G.e, A., Teji Roba, K., Egata, G. & Gebremichael, B. (2019). Anemia and associated factors among type-2 diabetes mellitus patients attending public hospitals in Harari Region, Eastern Ethiopia. PLoS One, 14(12), e0225725. T., et al. (2001). Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis, 38(4), 803-812.
18. Kebede, S. A., Tusa, B. S. & Weldesenbet, A. B. (2021). Prevalence of Anaemia and Its Associated Factors among Type 2 Diabetes Mellitus Patients in University of Gondar      Comprehensive      Specialized Hospital.Anemia, 2021, 6627979.
19. National Hospital of    Endocrinology. (2012). National program on diabetes control and prevention. Medical Publisher Hanoi.
20. National Institutes of Health. (2016). USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes  and   Digestive          and                   Kidney Diseases.