EVALUATING THE IRON DEFICIENCY ANEMIA IN TYPE-II DIABETIC PATIENTS TAKING METFORMIN AND ITS ASSOCIATION WITH OXIDATIVE STRESS

M ASIF; N BANO; U ASIF; S NASIR; L SHEHBAZ; MJ IQBAL

doi:10.54112/bcsrj.v2024i1.1169

Authors

M ASIF Department Of Medicine, Khawaja Muhammad Safdar Medical College Sialkot, Pakistan
N BANO Department Of Gynae and Obs, Allama Iqbal Memorial Teaching Hospital Sialkot, Pakistan
U ASIF Department Of Obs and Gynae, Islam medical and Dental College, Sialkot, Pakistan
S NASIR Department Emergency Medicine, Ziauddin University and Hospital, Karachi, Pakistan
L SHEHBAZ Department Emergency Medicine, Ziauddin University and Hospital, Karachi, Pakistan
MJ IQBAL Department Of Pathology, Aziz Fatimah Medical And Dental College, Faisalabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1169

Keywords:

Anemia, Iron-Deficiency, Diabetes Mellitus, Metformin, Oxidative Stress, Vitamin Deficiency

Abstract

Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting individuals across various demographic groups. Objective: The main objective of the study is to find iron deficiency anemia in type-II diabetic patients taking metformin and its association with oxidative stress. Methods: This cross-sectional observational study was conducted at the outpatient department (OPD) of the Medical Unit at Khawaja Muhammad Safdar Medical College, Sialkot, during the study period from 1st January 2024 to 31st June 2024. Data were collected from 285 patients diagnosed with type 2 diabetes mellitus (T2DM) who were receiving metformin therapy. Patients were divided into two groups—Group A (patients with IDA) and Group B (patients without IDA)—and the oxidative stress markers were compared between these two groups. Results: Data were collected from 285 patients with 92 in Group A (IDA) and 193 in Group B (Non-IDA). The mean age of participants was 57.6 ± 9.4 years, with no significant difference between Group A (58.2 ± 9.1) and Group B (57.3 ± 9.6) (p = 0.422). Gender distribution was similar between groups (p = 0.601). The mean duration of diabetes was also comparable between the groups (8.3 ± 3.4 years in Group A and 8.0 ± 3.1 years in Group B, p = 0.572). However, HbA1c levels were significantly higher in Group A (8.3 ± 1.6%) compared to Group B (7.5 ± 1.3%) (p = 0.012), indicating poorer glycemic control in the IDA group. Conclusion: This study concludes that iron deficiency anemia (IDA) is prevalent among type 2 diabetic patients on metformin therapy, affecting approximately one-third of the study population. Additionally, there is a significant association between IDA and increased oxidative stress, as evidenced by elevated levels of malondialdehyde (MDA) and reduced antioxidant enzymes (SOD and GPx) in patients with anemia.

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References

Pasricha S-R, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. The Lancet. 2021;397(10270):233-48.

Cappellini MD, Musallam KM, Taher AT. Iron deficiency anaemia revisited. Journal of internal medicine. 2020;287(2):153-70.

Group GSR. Glycemia reduction in type 2 diabetes—glycemic outcomes. New England Journal of Medicine. 2022;387(12):1063-74.

Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood, the Journal of the American Society of Hematology. 2014;123(5):615-24.

Fernández-Real JM, Manco M. Effects of iron overload on chronic metabolic diseases. The lancet Diabetes & endocrinology. 2014;2(6):513-26.

AlDallal SM, Jena N. Prevalence of anemia in type 2 diabetic patients. Journal of hematology. 2018;7(2):57.

Hizomi Arani R, Fakhri F, Naeimi Tabiee M, Talebi F, Talebi Z, Rashidi N, et al. Prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus in a referral diabetic clinic in the north of Iran. BMC Endocrine Disorders. 2023;23(1):58.

Farooqi M, Tahir Y, Rehan B. Anemia in patients with type 2 diabetes: A common but neglected clinical finding. Acta Bio Medica: Atenei Parmensis. 2022;93(1).

Guo W, Zhou Q, Jia Y, Xu J. Increased levels of glycated hemoglobin A1c and iron deficiency anemia: a review. Medical science monitor: international medical journal of experimental and clinical research. 2019;25:8371.

Davis RE, McCann VJ, Nicol DJ. Influence of iron-deficiency anaemia on the glycosylated haemoglobin level in a patient with diabetes mellitus. The Medical journal of Australia. 1983;1(1):40-1.

Soliman AT, De Sanctis V, Yassin M, Soliman N. Iron deficiency anemia and glucose metabolism. Acta Bio Medica: Atenei Parmensis. 2017;88(1):112.

Doyle-Delgado K, Chamberlain JJ, Shubrook JH, Skolnik N, Trujillo J. Pharmacologic approaches to glycemic treatment of type 2 diabetes: synopsis of the 2020 American diabetes association's standards of medical care in diabetes clinical guideline. Annals of internal medicine. 2020;173(10):813-21.

Lipska KJ, Yao X, Herrin J, McCoy RG, Ross JS, Steinman MA, et al. Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006–2013. Diabetes care. 2017;40(4):468-75.

Tan YZ, Cheen MHH, Goh SY, Bee YM, Lim PS, Khee GY, et al. Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017. Journal of diabetes. 2019;11(7):573-81.

Yang W, Cai X, Wu H, Ji L. Associations between metformin use and vitamin B12 levels, anemia, and neuropathy in patients with diabetes: a meta‐analysis. Journal of diabetes. 2019;11(9):729-43.

Adetunji O, Mani H, Morgan C, Gill G. Metformin and anaemia: myth or reality? Practical Diabetes International. 2009;26(7):265-6.

Donnelly LA, Dennis JM, Coleman RL, Sattar N, Hattersley AT, Holman RR, et al. Risk of anemia with metformin use in type 2 diabetes: a MASTERMIND study. Diabetes Care. 2020;43(10):2493-9.

Zhang Q-S, Tang W, Deater M, Phan N, Marcogliese AN, Li H, et al. Metformin improves defective hematopoiesis and delays tumor formation in Fanconi anemia mice. Blood, The Journal of the American Society of Hematology. 2016;128(24):2774-84.

Yang J, Zhou Y, Xie S, Wang J, Li Z, Chen L, et al. Metformin induces Ferroptosis by inhibiting UFMylation of SLC7A11 in breast cancer. Journal of Experimental & Clinical Cancer Research. 2021;40(1):206.

Wang Z, Wu Y, Wu J, Wang M, Wang X, Wang J, et al. Trends in prevalence and incidence of type 2 diabetes among adults in Beijing, China, from 2008 to 2017. Diabetic Medicine. 2021;38(9):e14487.