Anaemia in diabetic foot ulceration

NewsBot · Sep 10, 2014

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Presence and characterisation of anaemia in diabetic foot ulceration.
Wright JA, Oddy MJ, Richards T.
Anemia. 2014;2014:104214

Introduction. Diabetic foot ulceration (DFU) is the commonest cause of severe limb ischaemia in the western world. In diabetes mellitus, anaemia is frequently unrecognized, yet studies have shown that it is twice as common in diabetics compared with nondiabetics. We aimed to assess the incidence of anaemia and further classify the iron deficiency seen in a high-risk DFU patient group.

Methods. An observational study was undertaken in a multidisciplinary diabetic foot clinic setting. All patients with DFU attending over a four-month period were included. Anaemia was defined as haemoglobin (Hb) levels <12 g/dL. Iron deficiency was classified according to definitions of AID (absolute iron deficiency) and FID (functional iron deficiency).

Results. 27 patients had DFU; 14 (51.9%) were anaemic; two (7.41%) had severe anaemia (Hb < 10 g/dL). No patient had B12 or Folate deficiency. In patients with anaemia, there was significant spread of indices. Only one patient had "textbook" absolute iron deficiency (AID) defined as low Hb, MCV, MCH, and ferritin. Functional iron deficiency (FID) was seen in a further seven patients (25.5%).

Conclusion. Anaemia and iron deficiency are a common problem in patients with DFU. With current clinical markers, it is incredibly difficult to determine causal relationships and further in-depth scientific study is required.
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NewsBot · Jan 22, 2015

The Role of Iron Deficiency Anaemia & Connexin 43 in Poor Wound Healing
Wright, JA; (2014)
Doctoral thesis, UCL (University College London).

Background Patients with diabetes have a 10% life-time risk of developing diabetic foot ulceration (DFU). DFU is the commonest cause of severe limb ischaemia in the western world. In diabetes mellitus, anaemia is frequently unrecognized. Recently, cell-to-cell interactions, via gap-junctional communication have been shown to play a key role in the molecular biology of wound-healing. Gap-junction channels are assembled of transmembrane proteins called connexins (Cx). Over-expression of Cx43 in wounded skin is associated with both a direct negative effect on keratinocyte and fibroblast migration and delayed wound-healing.

Aims The aim of this thesis was to examine the problem of anaemia in patients with poorly-healing DFU. Further, to investigate the prevalence and type of anaemia seen in the high-risk severe DFU patient group, and to determine the current service provision required. Finally, to gain further scientific understanding of the wound-healing process and roles of anaemia and Cx43. Findings In severe DFU patients, >75% have iron deficiency anaemia, although a significant spread of indices was observed. Functional Iron Deficiency (FID) was seen in 25.5%. With current clinical markers, it is incredibly difficult to determine causal relationships. An in-vivo full-thickness excisional wounding study demonstrated that Hb decline correlated with slower re-epithelialisation (p=0.0060). Full-thickness skin biopsies taken from severe limb ischaemia patients demonstrated abnormal histological features in association with increased epidermal Cx43 expression at the wound-edge. 80% of unwounded surgically-viable skin showed persistence of these abnormal features not previously described.

Conclusion In severe DFU patients, a high incidence of anaemia and FID was observed Identification of anaemia, AID and FID in this patient group is necessary to assess the role of therapeutic strategies. This is the first detailed in-vivo histological study to demonstrate that iron-deficiency anaemia may play a role in delayed wound-healing. Abnormal Cx43 dynamics in severe limb ischaemia may also represent a novel future therapeutic target.
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NewsBot · Jul 21, 2016

Anemia in Patients With Diabetic Foot Ulcer
Prevalence, Clinical Characteristics, and Outcome
Fengning Chuan et al
International Journal of Lower Extremity Wounds July 20, 2016

The aim of this study was to describe the characteristics of diabetic foot ulcer (DFU) patients with anemia and assess the relationship between anemia and DFU outcome. A retrospective cohort study was conducted on patients with DFU who attended our hospital from May 2007 to September 2014. All of the variables in the DFU patients with and without anemia were compared. In this study, 353 subjects were included, anemia was present in 236 patients (66.9%). These patients were significantly male, more likely to be a smoker, had a lower level of serum albumin and worse kidney function, more likely to use at least 2 types of antibiotics and had a worse perfusion of the lower limb, a larger and deeper ulcer and a more severe infection. A multivariate analysis showed that male sex, lower serum albumin, and worse kidney function were independent predictors of anemia in DFU patients. Additionally, in multivariate models, anemia was one of the variables that was most significantly associated with adverse outcomes and with similar findings for secondary outcomes. Receiver operating characteristic analysis determined a hemoglobin cutoff of 12.3 g/dL (females) and 12.1 g/dL (males) to identify a high-risk population of DFU patients who would have adverse outcomes. So anemia is common in patients with DFU. Although typically mild or moderate, anemia has been associated with substantial morbidity and mortality in patients with DFU.
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NewsBot · Jan 16, 2019

Anemia in Patients with Diabetic Foot Ulcer: Effects on Diabetic Microvascular Complications and Related Conditions.
Olgun ME et al
Endocr Metab Immune Disord Drug Targets. 2019 Jan 11.

OBJECTIVE:
We aimed to investigate the etiology and prevalence of anemia in patients with diabetic foot ulcers and the relationship between both microvascular complications and related conditions and anemia.

METHOD:
We retrospectively collected and evaluated the data of 225 patients with diabetic foot ulcer followed at our clinic. The demographic characteristics of the patients were analyzed. Complete blood count and for those with anemia, serum iron, iron-binding capacity, ferritin, transferrin saturation index, vitamin B12, folic acid and thin blood film were performed. The diabetic microvascular complications and related conditions such as osteomyelitis, peripheral artery disease, and amputations were also determined. IBM SPSS Statistics Version 20.0 package software was used for the statistical analysis of the data.

RESULTS:
Of 225 patients were 67 (29%) female and 158 (70.2%) male. The mean age of the patients was 62 ± 10.5 years (30-87). Duration of diabetes was 16.2 ± 6.7 years (2-31). Of 225 patients, 41 had hypertension, 14 had chronic kidney failure, and 34 had coronary artery disease. Anemia was found in 192 (85.3%) of 225 patients. Of 192, 126 (56%) had iron deficiency anemia, 50 had folate-deficiency anemia, and the remaining 16 had anemia of chronic disease. Iron deficiency anemia was significantly found to be higher in women. There was no significant difference between patients with and without anemia in terms of diabetic microvascular complications (neuropathy, retinopathy, nephropathy) and the related conditions.

CONCLUSION:
We have found that the most common cause of anemia was iron deficiency anemia. However, in our study, the prevalences of microvascular complications did not vary between patients with and without anemia. On the other hand, due to in all of our patients are having DFU and the high rates of microvascular complications, correlation with the presence of anemia could not be clearly portrayed.
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NewsBot · Sep 8, 2019

Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center.
Shareef AM et al
Pak J Med Sci. 2019 Sep-Oct;35(5):1216-1220

BACKGROUND & OBJECTIVE:
Anemia is common finding in people with diabetes and diabetic foot ulcers. Therefore, our objective was to observe and compare the association of anemia in people with diabetic foot ulcers (DFUs) with age and sex matched people without DFUs.

METHOD:
This prospective case control study was undertaken at a multidisciplinary diabetic foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE) between October 2014 and October 2015. Participants were categorized into two groups; Case group (people with DFUs) and Control group (people without DFUs). Baseline demographic characteristics, biochemical and hematological parameters were recorded. University of Texas (UT) classification system was used to grade and stage DFU in case group. Subjects with other apparent causes of anaemia were excluded. Age and sex matched controls were taken from diabetic clinic presented during same time period. Data was analyzed by using statistical package for social science (SPSS) version 20.

RESULTS:
Total of 161 participants in case group were compared with similar number of age and sex matched participants of control group. Most of the participants were males 119(73.9%). Age and sex matched case and control groups were comparable except for duration of diabetes, BMI and HDL levels. Overall, 85.67% case group (males 64.56%); females 21.11%) and 35.3% control group (males 22.9%; females12.4%) have anemia. Mean Hb level was 10.49g/dl in case group and 13.39g/dl in control group. Significant differences were also noted in other blood parameters.

CONCLUSION:
Our study concludes that anaemia is strongly associated with DFU disease. Anaemia should be considered and treated as co-morbidity while managing patients with foot ulcers.
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NewsBot · Dec 25, 2019

Anemia in patients with diabetic foot ulcer and its impact on disease outcome among Nigerians: Results from the MEDFUN study.
Gezawa ID et al
PLoSOne. 2019 Dec 17;14(12):e0226226. doi: 10.1371/journal.pone.0226226. eCollection 2019.

BACKGROUND:
Diabetes is a life-long and debilitating disease that is fraught with both acute and chronic complications. Of particular concern to sufferers of the disease is the development of foot problems. These problems range from foot deformities to slowly healing or non-healing ulcers (that may necessitate amputation) and in the worst-case scenario, to death. Identification and prompt treatment of comorbid conditions, such as anemia may improve outcome in patients with diabetic foot ulcers (DFU). We determined the prevalence of anemia in Nigerians with DFU and its impact on disease outcome.

METHODS:
We prospectively followed 336 patients with diabetes hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. We evaluated each patient for neuropathy, vasculopathy and medical co-morbidities. Relevant laboratory and imaging studies were performed. We present the results of the sub-group analysis of patients with anemia to determine its prevalence and impact on disease outcome in patients with DFU in the MEDFUN study.

RESULTS:
Anemia was detected in 180(53.6%) subjects with 88(48.9%) of them requiring blood transfusion. Significant demographic and clinical determinants of anemia were ulcer duration more than one month prior to hospitalization (p<0.009), PAD (p<0.001) and presence of gangrene (p<0.001). The comorbid conditions that were significantly associated with anemia included proteinuria (p<0.003), osteomyelitis (p<0.006), moderate (p<0.002) as well as severe (p<0.001) vascular stenosis, history of stroke (p<0.014) and renal impairment (p<0.002). Anemia was significantly associated with poor wound healing (p<0.009), amputation (p<0.036) and risk of death (p<0.034).

CONCLUSION:
We detected anemia in more than half of our cohort with DFU. We found significant association between anemia and poor wound healing, amputation and mortality among our studied subjects. Future studies should explore whether prompt correction of anemia in subjects hospitalized for DFU would improve outcome.
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NewsBot · Feb 18, 2021

Is there an association between anemia and diabetic foot ulcers? A systematic review and meta-analysis
Kaissar Yammine et al
Wound Repair Regen. 2021 Feb 16

Anemia was found to be prevalent in patients with diabetes mellitus. Higher rates of anemia were reported in patients having diabetic foot ulcers (DFU). With the presence of an altered microcirculation, the potential negative effects of anemia might impede ulcer healing leading to higher rates of amputation and mortality. Medline, Embase, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched for from inception to locate relevant papers reporting any association between anemia and diabetic foot ulcers. The meta-analysis included 15 studies with 2895 patients. The weighted prevalence anemia rates of the total, mild-to-moderate DFU, and severe DFU groups were as follows: 69.7%, 49.5%, and 73%, respectively. For the hemoglobin level outcome, the same samples yielded the following pooled means: 11.00 ± 1.13, 12.08 ± 0.8, and 10.57 ± 0.68 g/dl. Individual studies showed association between low levels of hemoglobin and higher rates of non-healing ulcer, amputation, and mortality. This review demonstrated (a) a clear association between the presence of anemia and diabetic foot ulcers, (b) a clear association between the severity of anemia and the severity of DFUs, and (c) that anemia could be a predictor of amputation and mortality. Whether anemia is a predictor of adverse outcomes or an independent risk factor is to be further investigated.
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NewsBot · Aug 7, 2021

A study to assess anemia and hypoalbuminemia in
diabetic patients with ulcers
Devaprashanth M et al.
Int Surg J. 2021 Aug;8(8):2324-2327

Background: Diabetic foot is a severe public health issue. Nutrition is important in the repair of soft tissue injuries and
wound healing and specific nutrients have been shown to enhance wound healing. Anemia and hypoalbuminemia are
among the commonly encountered deficiencies in patients. Early detection of nutritional deficiencies and their prompt
treatment is imperative for the effective management of diabetic foot ulcers. The aim of the study was to investigate the
prevalence of anemia and hypoalbuminemia in diabetic foot patients presenting at our institution.
Methods: Hemoglobin and albumin levels of 175 patients with diabetic foot were collected. Data was tabulated and
analysed with descriptive statistics.
Results: Hemoglobin varied from 6.5 g/dl to15 g/dl (10.5±2.3 g/dl). 116 (66.28%) patients had anemia. Among the 66
female patients, 43 (65.15%) had anemia. Among the 109 male patients, 73 (66.97%) had anemia. 11 of the 29 patients
aged less than 40 had anemia (37.93%), while 105 of the 146 (71.91%) patients above 40 years had anemia. Albumin
levels ranged from 1.6 g/dl to 5.4 g/dl (3.3±1.06 g/dl). 93 (53.14%) patients had hypoalbuminemia. 33 of the 66 female
patients (50%) had hypoalbuminemia. 60 (55.04%) of the 109 male patients had hypoalbuminemia. 4 of the 29 (13.79%)
patients below 40 years had hypoalbuminemia 89 of the 146 patients (60.9%) above 40 years had hypoalbuminemia.
Conclusions: Anemia and hypoalbuminemia are common in patients with diabetic foot ulcers, with males being more
commonly affected by both than females and older age group being more commonly affected than younger age group.
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NewsBot · Apr 20, 2022

The Characteristics of Anemia Among Patients with Diabetic Foot Infection

NewsBot · Sep 5, 2022

Severe anemia, anorexia, and uremia associated with diabetic foot infections: A case series
Jennifer L Den et al
Foot (Edinb). 2022 May 4

Anemia of inflammation, as found in many chronic disease states, is common among persons with diabetic foot infections but is typically mild and self-limited. Herein we present four cases of patients with foot infections accompanied by severe anemia (nadir hemoglobin <8 gm/dL and resulting in transfusion of 4 + units of blood) as well as significant weight loss (30 + pounds), hyponatremia (<135 mmol/L), hypoalbuminemia (nadir <2 gm/dL), uremia and other metabolic derangements.
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NewsBot · Sep 28, 2022

Anemia prevalence among patients with diabetic foot ulcers necessitating surgery on admission: a preliminary, retrospective comparative study
Kaissar Yammine et al
Wounds. 2022 Aug;34(8):216-219.

Introduction: Anemia is significantly more prevalent in patients with diabetic foot complications. Severity of anemia has been shown to be associated with severity of DFD. The association between Hb level and DFU has rarely been investigated in surgical settings.

Objective: This study compares Hb level in patients undergoing conservative surgical treatment of DFU based on initial status of infection.

Materials and methods: Retrospective comparative analysis was made between 2 groups of patients based on the presence or absence of infection in the diabetic wounds.

Results: Of the 37 patients studied, 21 had noninfected ulcers and 16 had infected ulcers. The mean Hb levels for the noninfected group and the infected group were 11.7 g/dL ± 2.4 and 10.3 g/dL ± 2.1, respectively (P =.033). A positive correlation was found between Hb level and DFU severity (ie, noninfected vs. infected) (P =.03). For other risk factors, a high correlation was recorded between Hb and serum creatinine level only (P =.025).

Conclusions: Patients with an infected DFU and those with impaired renal function were more likely to have lower Hb levels. In such patients, early evaluation of Hb levels with subsequent treatment based on those values might positively affect clinical outcomes.
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NewsBot · Apr 20, 2023

Strong Association Between Anemia And Diabetic Foot Ulcers (Dfus): A Single-Center Study
Muhammad Hussain Afridi , Muhammad Naeem Khan , Fasih Iqbal , Akbar Shah , Kifayat
SOurce

Background :Anemia and diabetic foot ulcers are two common side effects of diabetes. We set out to collect information on the prevalence of anaemia in people with and without diabetic foot ulcers (DFUs) who were of comparable ages and sexes to investigate the association between anemia and diabetic foot ulcers (DFUs) in patients with diabetes. A total of 371 patients with diabetes and DFUs from a tarrtery care hospital of kpk , pakistan .

Method
The study conducted in department of Diabetes and endocrinology Hayatabad Medical Complex Peshawar from October 2019 to October 2021 A total of 371 patients with diabetes were included in the study. Data were collected from medical records regarding demographics (age, gender, body mass index, etc.), clinical characteristics (hemoglobin [Hb] level, anemia, etc.), and DFUs. Anemia was defined as a Hb level less than 13.0 g/dl for men and 12.0 g/dl for women. DFUs were defined as any ulcer on the foot that was present or had been present in the previous 12 months.

Results
Out Of the 371 patients included in the study, 120 (32.4%) had anemia. The results showed that patients with anemia were more likely to have DFUs than those without anemia (odds ratio [OR] = 2.48; 95% confidence interval [CI], 1.79- 3.45). Additionally, an inverse association was found between Hb level and DFUs (OR = 0.99; 95% CI, 0.99-0.99). Other potential risk factors for DFUs, such as age, gender, body mass index, and duration of diabetes, were not significantly associated with DFUs.

Conclusion
This Single-center study demonstrated a strong association between anemia and DFUs in patients with diabetes. The findings suggest that screening and timely treatment of anemia should be considered in the prevention and management of DFUs.
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NewsBot · Jul 6, 2023

Association between anemia and the risk and outcomes of
diabetic foot in patients with type 2 diabetes mellitus
JING LI et al
EXPERIMENTAL AND THERAPEUTIC MEDICINE 26: 384, 2023

The aim of the present study was to explore the
association between anemia and the risks and outcomes of
diabetic foot (DF) in patients with type 2 diabetes mellitus
(T2DM). A total of 145 patients with T2DM were recruited
between January and December 2021 and divided into the
DF and non‑DF groups according to whether they were
diagnosed with DF. Individual patient data were extracted
and blood samples were evaluated in a biochemical center
for routine biochemical and blood‑related indicators. The
patients' survival rates were followed up until December
2022. An independent‑samples t‑test and χ2 test were used
to compare the differences between the two groups. The
association between the various clinical indicators for the
DF and non‑DF groups was evaluated using single‑factor
binary logistic regression analysis. Multi‑factor binary
logistic regression analysis was used to analyze the association
between hemoglobin (Hb) and the risk for DF. A
Kaplan‑Meier survival curve was used to analyze the impact
of anemia and DF on the 1‑year survival rate. The diabetes
duration, number of patients who smoked and consumed
alcohol, and serum creatinine and C‑reactive protein levels
in the DF group were significantly higher than those in
the non‑DF group (P<0.05). By contrast, the estimated
glomerular filtration rate (eGFR) and Hb, albumin (Alb) and
total cholesterol levels, were lower in the DF group when
compared with those in the non‑DF group (P<0.05). All of the
study participants were divided into two groups, according to
their baseline eGFR [eGFR ≥90 or <90 ml/(min x 1.73 m²)].
It was found that, independently of renal function, lower Hb
and Alb levels were associated with a higher incidence of DF.
The 1‑year survival rate for DF with anemia was significantly
lower when compared with that in patients with DF without
anemia (P<0.05). In conclusion, the Hb level in patients with
T2DM is a protective factor against DF and anemia is an
independent risk factor for DF. The present study suggested
that anemia is associated with a decrease in the survival rate
of patients with DF. This finding provided a theoretical basis
for the clinical correction of anemia and improvement of DF
prognosis
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NewsBot · Jul 18, 2023

The Prevalence of Anemia in Hospitalized
Patients With Diabetic Foot Ulcer (DFU) and the
Relationship Between the Severity of Anemia and
the Severity of DFU
Ritesh Kumar , Surya K. Singh , Neeraj K. Agrawal , Ujwal Kumar , Subhash Kumar , Supreeth C ,
Avina Bishnoi
Source

Background and aims: We aim to determine the prevalence of anemia in hospitalized patients with diabetic
foot ulcers (DFUs) and estimate the relationship between the severity of anemia and diabetic foot ulcer.
Materials and methods: We retrospectively collected and evaluated the data of 323 patients hospitalized
with diabetic foot ulcer (DFU). We included 299 type 2 diabetic patients with foot ulcers of neuropathic or
neuroischemic nature with infection. Anemia was defined based on World Health Organization (WHO)
criteria, and the severity of DFU was classified in University of Texas (UT) grades.
Results: Anemia was detected in 94.3% of DFU, and the prevalence of mild, moderate, and severe anemia
was 16.7%, 55.7%, and 27.6%, respectively. There was a significant difference in the mean hemoglobin (Hb)
levels among the patients with varying grades of severity of DFU (1B: Hb=10.17±2.08 gm/dL, 2B:
Hb=9.27±2.04 gm/dL, 3B: Hb=8.03±1.829 gm/dL; p value=<0.0001). The iron study was available in 141
(47.15%) patients and was suggestive of anemia of chronic disorder (mean serum iron=40.22±23.81 mcg/dL,
mean total iron-binding capacity (TIBC)=239.34±67.24 mcg/dL, mean ferritin=378.05±141.337 ng/mL). TIBC
significantly decreased (1B=262.13±61.05, 2B=233.65±71.26, 3B=222.43±74.18; p=0.04), and ferritin
significantly increased (1B=309.9±70.76, 2B=351.73±94.22, 3B=488.58±170.4; p<0.0001) with increasing DFU
severity. Hemoglobin was significantly decreased at the time of discharge in comparison to that at admission
(9.3±2.1 gm/dL versus 8.8±1.5 gm/dL; p value=0.01). Red blood cell (RBC) counts, mean corpuscular volume
(MCV), mean corpuscular hemoglobin concentration (MCHC), lymphocyte counts, albumin, calcium, and
high-density lipoprotein (HDL) significantly decreased with the increase of DFU severity. The duration of
hospitalization, total leucocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR)
increased with the severity of DFU.
Conclusions: The prevalence of anemia was very high in DFU and more than three-fourths of the patients
had moderate to severe anemia. The severity of anemia was associated with the severity of DFU. The most
common cause of anemia was anemia of chronic disorder secondary to diabetic foot infection. During the
period of hospitalization, hemoglobin decreased despite improvement in DFU infection.
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NewsBot · Aug 17, 2023

The Prevalence of Anemia in Hospitalized Patients With Diabetic Foot Ulcer (DFU) and the Relationship Between the Severity of Anemia and the Severity of DFU
Ritesh Kumar et al
Cureus. 2023 Jul 15;15(7):e41922

Background and aims: We aim to determine the prevalence of anemia in hospitalized patients with diabetic foot ulcers (DFUs) and estimate the relationship between the severity of anemia and diabetic foot ulcer.

Materials and methods: We retrospectively collected and evaluated the data of 323 patients hospitalized with diabetic foot ulcer (DFU). We included 299 type 2 diabetic patients with foot ulcers of neuropathic or neuroischemic nature with infection. Anemia was defined based on World Health Organization (WHO) criteria, and the severity of DFU was classified in University of Texas (UT) grades.

Results: Anemia was detected in 94.3% of DFU, and the prevalence of mild, moderate, and severe anemia was 16.7%, 55.7%, and 27.6%, respectively. There was a significant difference in the mean hemoglobin (Hb) levels among the patients with varying grades of severity of DFU (1B: Hb=10.17±2.08 gm/dL, 2B: Hb=9.27±2.04 gm/dL, 3B: Hb=8.03±1.829 gm/dL; p value=<0.0001). The iron study was available in 141 (47.15%) patients and was suggestive of anemia of chronic disorder (mean serum iron=40.22±23.81 mcg/dL, mean total iron-binding capacity (TIBC)=239.34±67.24 mcg/dL, mean ferritin=378.05±141.337 ng/mL). TIBC significantly decreased (1B=262.13±61.05, 2B=233.65±71.26, 3B=222.43±74.18; p=0.04), and ferritin significantly increased (1B=309.9±70.76, 2B=351.73±94.22, 3B=488.58±170.4; p<0.0001) with increasing DFU severity. Hemoglobin was significantly decreased at the time of discharge in comparison to that at admission (9.3±2.1 gm/dL versus 8.8±1.5 gm/dL; p value=0.01). Red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), lymphocyte counts, albumin, calcium, and high-density lipoprotein (HDL) significantly decreased with the increase of DFU severity. The duration of hospitalization, total leucocyte counts, neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) increased with the severity of DFU.

Conclusions: The prevalence of anemia was very high in DFU and more than three-fourths of the patients had moderate to severe anemia. The severity of anemia was associated with the severity of DFU. The most common cause of anemia was anemia of chronic disorder secondary to diabetic foot infection. During the period of hospitalization, hemoglobin decreased despite improvement in DFU infection.
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NewsBot · Oct 23, 2023

In blood we trust: anemia as a negative healing prognostic factor in diabetic foot patients
Francesco Giangreco, Elisabetta Iacopi, Vittorio Malquori, Letizia Pieruzzi, Chiara Goretti & Alberto Piaggesi
Acta Diabetologica (2023)

Aim
Anemia has been associated with severity of diabetic foot (DF) disease. Our study aimed to evaluate whether the presence of anemia could decrease the healing chances in DF.

Methods
We retrospectively analyzed all patients admitted in our department in 2021 for DF, dividing them according to presence (Group A) or absence (Group B) of anemia. Groups were compared for clinical and demographic characteristics, procedures and outcomes: healing rate (HR) at 6 months, healing time (HT) and recurrence rate (RR) at 12 months.

Results
We sorted out data from 196 consecutive patients: 114 (58%) in Group A and 82 (42%) in B. Group A had a higher male prevalence and a longer duration of disease. Group A showed lower hemoglobin concentration (10.3 ± 1.3 g/dL vs 13.1 ± 1.4 g/dL, p < 0.002) and red blood cells count (3.4 ± 0.5 × 106/mL vs 4.8 ± 0.6 × 106/mL, p = 0.004). Group A presented a lower HR (55.2% vs 76.8%, p = 0.0028), no differences in HT and a higher RR (23.6% vs 17.1%, p < 0.02). Cox’s logistic regression on healing confirmed the negative impact of anemia: hazard ratio 2.8 (CI 95% 1.4–5.4, p = 0.0037).

Conclusions
Anemia is frequent in DF and associates to a reduction in healing chances and an increase in recurrences representing an independent predictor of healing failure.
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NewsBot · Feb 29, 2024

Prevalence of Anemia in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis
Monireh Faghir-Ganji et al
Biomed Environ Sci. 2024 Jan 20;37(1):96-107

Objective: Anemia is a common public health concern in patients with type 2 diabetes worldwide. This study aimed to identify the prevalence of anemia among patients with diabetes.

Methods: Electronic databases, including PubMed, Scopus, Web of Sciences, and Google Scholar, were searched systematically for studies published between 2010 and 2021. After removing duplicates and inappropriate reports, the remaining manuscripts were reviewed and appraised using theNewcastle-Ottawa Scale (NOS) tool. A random-effects model was used to calculate the pooled estimates of the extracted data using Stata version 17. Heterogeneity of the studies was assessed using the Q statistic.

Results: A total of 51 articles containing information on 26,485 patients with diabetes were included in this study. The articles were mainly from Asia (58.82%) and Africa (35.29%). The overall prevalence of anemia was 35.45% (95% CI: 30.30-40.76), with no evidence of heterogeneity by sex. Among the two continents with the highest number of studies, the prevalence of anemia in patients with diabetes was significantly higher in Asia [40.02; 95% CI: 32.72-47.54] compared to Africa [28.46; 95% CI: 21.90-35.50] ( P for heterogeneity = 0.029). Moreover, there has been an increasing trend in the prevalence of anemia in patients with diabetes over time, from [15.28; 95% CI: 9.83-22.21] in 2012 to [40.70; 95% CI: 10.21-75.93] in 2022.

Conclusion: Globally, approximately 4 in 10 patients with diabetes suffer from anemia. Therefore, routine anemia screening and control programs every 3 months might be useful in improving the quality of life of these patients.
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