A Review on Prevalence and Iatrogenic Etiologies of Anemia in Type 2 Diabetes Mellitus

Review Article

Abstract

Diabetes mellitus constitutes a rapidly expanding global health burden, significantly impacting morbidity and mortality through microvascular and macrovascular complications. Among these, anemia frequently manifests as an underdiagnosed comorbidity in patients with Type 2 Diabetes Mellitus (T2DM), often appearing earlier and with greater severity than in non-diabetic renal disease. This article elucidates the multifactorial pathogenesis of anemia in T2DM, moving beyond the traditional attribution to diabetic nephropathy alone. The pathophysiology involves a complex interplay of chronic systemic inflammation, inappropriate erythropoietin response, autonomic neuropathy, and nutritional deficiencies. Crucially, the management of hyperglycemia and associated hypertension introduces iatrogenic risks that exacerbate hematological indices. Pharmacological interventions, specifically biguanides (metformin), Thiazolidinediones (TZDs), and Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, contribute to hemoglobin reduction through distinct mechanisms ranging from vitamin B12 malabsorption to erythropoiesis suppression and hemodilution. Identifying these drug-induced etiologies is paramount for clinical management. This review discusses about the current epidemiological data with insights into iatrogenic anemia, emphasizing the necessity for routine hematological screening to mitigate cardiovascular risks and improve quality of life in the diabetic population