Anemia, Mortality, and Type 2 Diabetes

Health care providers out there may have noticed that anemia is a not-infrequent finding amongst patients with type 2 diabetes.

It turns out that there are multiple reasons for anemia in type 2 diabetes - and the health consequences may be severe.

A study was recently published evaluating the prevalence, risk factors, and prognosis of anemia in two groups of Australian patients.  They found that the prevalence of anemia was double to triple in people with type 2 diabetes, compared to people without diabetes.

They found multiple risk factors independently associated with a higher risk of anemia, including:

• impaired kidney function: related at least in part to reduced erythropoeitin production by the kidneys, which is a hormone that stimulates red blood cell production
• longer duration of diabetes: 5% increased risk of anemia per year of having diabetes - may be due to decreased red blood cell production and/or increased destruction, as consequences of chronically elevated blood sugar
• metformin use: likely related to vitamin B12 deficiency, but other mechanisms such as low magnesium are considered
• thiazolidinedione use [pioglitazone (Actos) or rosiglitazone (Avandia)]: likely related to fluid retention
• peripheral arterial disease: possibly related to higher oxidative stress, inflammation, atherosclerosis

Other risk factors were identified as well, such as low iron, and low testosterone in men.

After adjustment for other independent predictors of mortality, anemia was associated with a 57% increased risk of mortality over the mean of 4.3 years of study, compared to people with diabetes but without anemia.

The good news is that many of these risk factors for anemia are treatable, and even preventable.  For example: optimizing blood sugar control; checking vitamin B12 in people on metformin; checking iron levels in people who are anemic and investigating for the cause of low iron if so.

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www.drsue.ca © 2017

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Does Gastric Bypass Surgery Save Lives Only In People With Diabetes?

While we know that weight loss of just 5-10% is associated with an improvement in many parameters of health, the only treatment for obesity that has been suggested to reduce mortality is bariatric surgery.  A new study suggests that if gastric bypass surgery reduces mortality, it may be people with diabetes in particular who enjoy this benefit.

The study, published in Diabetes Care, matched 2,428 people in their database who had gastric bypass surgery by age, BMI, gender, and diabetes status to a control group in the database who had not had surgery.

They found that for the 625 people who had diabetes before gastric bypass surgery, their risk of death from any cause was reduced by 56% at 5.8 years after surgery, compared to people who had diabetes but hadn't had surgery.  In particulary, death from cardiovascular disease, lung disease, and diabetes were lower in the group who had surgery.  The reduction in mortality was the greatest for people whose diabetes went into remission after surgery.

For the 1,803 people who didn't have diabetes before gastric bypass surgery, the risk of death at 6.7 years after surgery was not significantly different than those who didn't have diabetes and didn't have surgery.  When they boiled it down, the risk of death from cancer and lung diseases was lower in the people who had had gastric bypass surgery, but the risk of death from external causes (including injuries, overdose, and suicide) was higher, especially for younger people.

This study is the first to suggest that a reduction in all-cause mortality after gastric bypass surgery may be limited to people who have diabetes before surgery.  However, even if people without diabetes don't enjoy enhanced life expectancy overall, remember that there are still many health benefits to be enjoyed from bariatric surgery.   It's also important to emphasize that this study is retrospective, meaning that researchers looked back in time and analyzed pre existing data.  This type of data can be muddied by other factors that can't be controlled for (called 'confounding factors'), so we have to take them with a grain of salt.

The increased death risk from injuries, overdose, and suicide for people without diabetes who had surgery needs attention. It is known that there is a higher risk of self harm after surgery, pointing towards the need for psychological counselling and support both pre and post surgery.  There is still very little known about how bariatric surgery changes the absorption of medications and other substances, increasing the risk of potential overdose; further studies are desperately needed in this area.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2017

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