Anaemia, a frequent hematological condition, is characterized by the inability of the body to generate sufficient red blood cells (RBCs) to fulfill its physiological requirements. Following the World Health Organisation (WHO), this condition is defined as having a blood glucose level lower than 130 g/L for males and lower than 120 g/L for females (1).  According to the World Health Organisation (WHO), iron deficiency anemia is accountable for around fifty percent of all cases of anemia(2). According to the findings, the incidence of IDA is 2.5 times more prevalent than the incidence of anemia alone(3).

According to the findings of one research (4), diabetes mellitus is the leading cause of mortality and disability worldwide, accounting for more fatalities by far than any other illness. Insulin-dependent diabetes mellitus affects about 382 million individuals throughout the world, with a prevalence rate of 8.3%. Only 2% of Kuwaitis between the ages of 0-22%of people born in Kuwait are diagnosed with type 1 diabetes. Among Asian expatriates in the age range of 30 to 60 years old, the prevalence of type 2 diabetes was 25.4%, which is greater than the prevalence of the disease in the local population(5).

Type 1 and type 2 diabetes mellitus are distinguished by how much the body relies on insulin. Type 1 diabetes, insulin-dependent diabetes, and juvenile diabetes develop when the immune system mistakenly targets and kills the pancreatic beta cells responsible for insulin production. There are other forms of diabetes mellitus, but the most serious one is type 1. Insulin treatments are not necessary for the treatment of type 2 diabetes mellitus, which often has insulin resistance as its underlying cause. Estimates put the lifetime prevalence of type 2 diabetes in women who acquire gestational diabetes at 25% to 50%(6).

The proportion of patients who suffer from anaemia is much greater among those who have type 2 diabetes in comparison to the whole population (7). According to recent study, people who have diabetes have a higher chance of developing cardiovascular and end-stage renal illnesses if they had a history of being anaemic in the past. As shown by Keane and Lyle (2003) (4), individuals who have diabetes are at a greater risk of being hospitalised and of dying prematurely if their haemoglobin levels are lower than normal. However, 25% of those who have diabetes are afflicted by anaemia(5). According to the findings of theresearch, people who have diabetes are often associated with anaemia when renal insufficiency is present. When compared to non-diabetic individuals who have other types of renal failure, the incidence of anaemia in connection to renal impairment is higher in diabetes patients(8).Diabetes patients are more likely to get anemia at an early age due to several different causes. Systemic inflammation decreased erythropoietin production, injury to renal interstitial spaces, hyperglycemia, pharmacological effects, poor iron metabolism, and severe symptomatic autonomic neuropathy are some of the symptoms that may occur because of this condition(9).

According to research, diabetic patients who have renal insufficiency have a higher risk of acquiring anaemia because their erythropoietin production is lower than normal. Additionally, diabetic neuropathy influences the hormone that is necessary for the synthesis of red blood cells, which further contributes to the development of anaemia(10). Individuals who have diabetes may be at risk for developing many forms of anaemia due to deficits in cyanocobalamin, folate, and iron in their diet. By preventing the absorption of cyanocobalamin, metformin has the potential to stimulate the development of vitamin B12 deficient anaemia (11,12). Most people who have diabetes are unaware that they have anaemia because of the symptomatologic overlap that exists between anaemia and type 2 diabetes. This overlap manifests itself in symptoms such as chest discomfort, peripheral numbness or coldness, dyspnoea, and cephalalgia(13).

This study aimed to determine the extent to which persons diagnosed with type 2 diabetes mellitus who visited the OPD between July 2023 and July 2024. in the Rohilkhand area over a year were affected by anemia.

Aim of the study

The study aimed to determine the prevalence of anaemia among individuals with type 2 diabetes mellitus in Rohilkhand region.

Objective

To determine the prevalence of anaemia among individuals with type 2 diabetes mellitus in Rohilkhand region.

This study presents a retrospective analysis of outpatient clinic visits conducted by residents of the Rohilkhand area from July 2023 to July 2024. The ethical committee at the Health Centre approved the retrieval of data from the LIS prior to its collection.

Inclusion Criteria

Participants are adults of both sexes who have been diagnosed with type 2 diabetes mellitus. Initially, patients were categorised based on their glycaemic status, with a well-controlled HbA1C level of 7.5% or lower. Secondly, patients were classified as male or female. Thirdly, patients were categorised based on the presence of anaemia, which was defined as a less than 13 g/dL for men and less than 12 g/dL for women, as per the gender-specific criteria of the World Health Organisation.

Exclusion Criteria

• Patients diagnosed with type 1 diabetes were not allowed to participate in this research.

Data Collection

During a one-year period, starting on July 2023, and concluding in July 2024, researchers meticulously monitored the data gathered from the participants. The criteria utilised for data extraction from each individual case record included age, gender, haemoglobin (Hb) value, and haemoglobin A1Cvalue.

Data Analysis

Using descriptive analysis, the study sample was defined based on demographic parameters such as gender, age, anaemia, and HbA1C level.  Statistical analysis was carried out using SPSS Version 20.0 with a significance of P < 0.05 was used in this study.

Table 1. Sociodemographic Characteristics of the Participants

The demographic information and glycaemic control status of the people who participated in the study are shown in Table 1. Evaluations were performed on a total of 20,433 different people. Mean age of patients of Diabetes with Anemia was 45-50 years.  The gender distribution showed that there were 10,540 male participants, which accounted for 52 percent of the total, and 9,890 female participants, which accounted for 48 percent of the total. A classification system was used to classify the participants according to their current level of glycaemic control and blood sugar management. There was a total of 14,095 patients who exhibited efficient management of their glycaemic state via the regulation of their blood sugar levels. This represents 69% of the treatment population. Despite this, 3.13% of the participants, or 6,335 people, had blood sugar levels that were not under control, which suggests that a sizeable proportion of people had difficulty maintaining appropriate blood glucose levels.

Table 2. Clinical Profile of the Participants

Table 2 provides a detailed overview of the clinical characteristics of the 20,430 participants. The first step is to sort the data by people's glycaemic control status. The data is then further categorised based on the anaemia prevalence.There were 6,150 individuals (30.1% of the total) with poorly controlled glycaemic levels among the participants. In contrast, 14,280 people (or 69.9% of the total) had levels that were within control.

The two groups who took part in the study were both tested for anaemia. Even though their blood sugar levels were within normal range, 6,180 (30.02%) individuals were discovered to be anaemic. The study found that anaemia was more common among females than men in this group, with 3,840 participants (62.1% of the total) being categorised as female and 2,340 as male (37.9% of the total). Out of the total number of persons with poorly regulated glycaemic levels, 2,220 (36.1%) were diagnosed with anaemia. A total of 1,320 females (or 39.5% of the total) and 900 males (or 40.5% of the total) made up the study participants. Consistent with the findings of the strong control group, the anaemia rate was higher in the female-dominated group with inadequate control.

The data shows a distinct pattern: those with poorly controlled blood sugar levels are more likely to have anaemia (36.1% vs. 27.7%). Furthermore, it seems from both datasets that anaemia is more common in women than in men.According to the study, anaemia is more common in those with poor blood sugar management. People who already have problems maintaining normal blood sugar levels may be at a higher risk of developing the illness, according to this new information. The results highlighted the critical need to narrow the gender disparity in anaemia rates.

Table 3. Prevalence of Anemia Among Participants

A total of 20,430 individuals were included in the study, with 10,039 men and 10,391 women taking part. Of the entire male population, 2,340 individuals (or 37.9% of the total) were determined to be anaemic. The percentage of female participants who were anaemic was 62.1%, with 3,840 out of 10,391 being affected. As part of the study, the participants' ability to maintain a steady blood sugar level was assessed once more. Out of 14,280 individuals whose diabetes was under control, 3,980 were determined to be anaemic. This number accounts for 27.9% of the whole sample size. It was found that 2,200 out of 6,150 people in the group of poorly controlled diabetes were anaemic. This amounts to 33.46% of the whole population that falls within this group. The findings support the hypothesis that glycaemic management and gender play a role in explaining observed differences in anaemia prevalence.

This Research was conducted in the Rohilkhand region between July 2023 and July 2024 to determine the prevalence of anemia in individuals diagnosed with type 2 diabetes. Regarding this aspect, it was discovered that 32 percent of the sample was afflicted by anemia, and there was a statistically significant difference between the sexes in question. Anaemia was more prevalent in females (62.1% of respondents) than in males (37.9% of respondents), a pattern seen across the study literature. Previous studies have shown that women who have diabetes are more likely to have consequences such as iron shortage, hormonal fluctuations, and chronic kidney illness. In comparison to diabetic males, diabetic women are at a greater risk of acquiring anemia, as shown by these statistics, which confirm global trends that indicate this situation. It is of the utmost importance to do more study on the gender differences in diabetes treatment.

According to the findings of the research, those with well-controlled diabetes were 27.9% more likely to suffer from anemia than those with poorly managed diabetes, which represented 33.46 percent of the total. People with diabetes who have insufficient control of their blood glucose levels are more likely to get anemia, which is consistent with the findings of the earlier study. Anemia may develop if blood sugar levels are not correctly maintained, which can lead to inflammation, decreased erythropoietin production, and renal failure. Studies have shown this can happen when blood sugar levels are not appropriately regulated. Inadequate control of glycaemic levels is a potential cause of anemia, as is conventional wisdom(14,15). People with type 2 diabetes who struggle to maintain control of their blood sugar levels are more likely to suffer from anemia. Specifically, this is because hyperglycemia has a cumulative effect on renal function and erythropoiesis, which might ultimately result in anesthesia.

A significant incidence of the illness was found among people with diabetes who were not receiving adequate treatment, as shown by the findings, which revealed that 36.1% of patients had anemia. This agrees with the findings of Ahmed et al., who discovered that individuals with diabetes who are unable to regulate their blood sugar levels effectively are more likely to have problems such as anemia, need hospitalization, and pass away at an earlier age(16). Several mechanisms contribute to the pathophysiology of this link. These processes include inflammation, chronic renal illness, and aberrant iron metabolism. Because of the factors that have been emphasized, it is essential for medical practitioners to include anemia screening in treating patients with poorly controlled diabetes. These factors are responsible for the increased prevalence of anemia and make diabetes management more difficult.

The findings of this study underscore the need to do regular evaluations of individuals who have type 2 diabetes and take prompt action if they develop anemia. Due to the high frequency of the illness in this population, particularly among women and those with impaired glycaemic control, screening for anemia needs to be carried out frequently as part of diabetes treatment programs. Studies conducted in the past have shown that the health outcomes of diabetic patients may be improved if the underlying causes of anemia, which include iron deficiency and renal insufficiency, are addressed appropriately(17,18). This consists of a potential reduction in the risk of cardiovascular events and a slowing of the progression of renal function decline. This study's findings emphasize the significance of an integrated approach to managing diabetes. This strategy should also address comorbidities such as anemia, which may worsen complications related to diabetes, in addition to focusing on blood sugar control.

Anemia is a condition that affects persons who have type 2 diabetes in the Rohilkhand region. This fact demonstrates the complex interaction that exists between gender, glycaemic control, and anemia in diabetic patients. Anaemia was shown to be more prevalent among people with poorly controlled diabetes, especially women, according to the findings of this study, which are in line with the findings of prior research carried out all over the globe. To improve patient outcomes and reduce the likelihood of problems, medical professionals should concentrate their efforts on screening and treating anemia in diabetic patients, especially those who have poor glycemic control. This is because anemia has a significant influence on diabetic patients, who are more likely to have consequences for the condition. The significance of integrated care strategies that treat both diabetes and anemia simultaneously is brought to light by this study, which also contributes significant new information to the existing body of literature on the subject.

This study underscores the high prevalence of anaemia among individuals with type 2 diabetes in the Rohilkhand region, with a notably higher incidence among women and those with poorly controlled blood sugar levels. Most commonly noticed anemia was iron deficiency anemia.   The findings align with existing literature that suggests poor glycaemic control exacerbates the risk of anaemia due to factors such as renal dysfunction, inflammation, and impaired erythropoiesis. Given the significant overlap between diabetes and anaemia, especially in patients with inadequate blood sugar management, the study highlights the critical need for routine screening and integrated care strategies to address both conditions. Effective management of anaemia in diabetic patients can potentially improve overall health outcomes, reduce complications, and enhance the quality of life for this vulnerable population.

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