Anemia and associated factors among type-2 diabetes mellitus patients attending public hospitals in Harari Region, Eastern Ethiopia

Autoři: Astarekegn Bekele aff001;  Kedir Teji Roba aff002;  Gudina Egata aff003;  Berhe Gebremichael aff003
Působiště autorů: Shekosh Health Center, Somali Regional State, Shekosh, Ethiopia aff001;  School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia aff002;  School of Public Health, Haramaya University, Harar, Ethiopia aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Anemia is a common complication of diabetes mellitus, therefore having a major impact on the overall health and survival of diabetic patients. However, there is a paucity of evidence of anemia among diabetic patients in Ethiopia, particularly in Harari Region. Therefore, this study aimed to assess the magnitude of anemia and associated factors among Type 2 Diabetes Mellitus (T2DM) patients attending public hospitals in Harari Region, Eastern Ethiopia.


A hospital based cross-sectional study was conducted from February 25 to March 30, 2019. Probability proportion to size sampling, followed by simple random sampling, was utilized to select 374 T2DM patients. To collect the data, mixed methods were applied using questionnaires and checklist. Participants were tested for anemia based on World Health Organization (WHO) criteria. Data was double entered to EpiData version 3.1 and exported into Stata version 14.0 for statistical analysis. Bivariate and multivariate logistic regression models were fitted; Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were computed. Level of significance was declared at p-value less than 0.05.


The study revealed 34.8% of the participants were anemic (CI: 28.7, 40.9). Being male (AOR = 2.92, CI: 1.65, 5.17), physical inactivity (AOR = 2.58, CI: 1.50, 4.44), having nephropathy (AOR = 2.43, CI: 1.41, 4.21), poor glycemic control (AOR = 1.98, CI: 1.17, 3.34), recent history of blood loss (AOR = 4.41, CI: 1.26, 15.44) and duration of diabetes for five years and greater(AOR = 1.72, CI: 1.01, 2.96)were all significantly associated with anemia.


Anemia was a major health problem among T2DM patients in the study area. Therefore, routine screening of anemia for all T2DM patients aiding in early identification and improved management of diabetes will lead to improved quality of life in this patient population.

Klíčová slova:

anémia – Data processing – Ethiopia – Food consumption – Hemoglobin – Physical activity – Questionnaires


1. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization. 2011. Available from:

2. WHO. Worldwide prevalence of anaemia 1993–2005: WHO Global Database on anaemia. 2008a. Available from:

3. Kassebaum N.J. Global Burden of Disease (GBD) 2013 Anemia Collaborators. The global burden of anemia. Hematol Oncol Clin North Am. 2016; 30: 247–308. doi: 10.1016/j.hoc.2015.11.002 27040955

4. Sahay M., Kalra S., Badani R., Bantwal G., Bhoraskar A., Das A.K., et al. Diabetes and Anemia: International Diabetes Federation (IDF)—Southeast Asian Region (SEAR) position statement. Diabetes Metab Syndr. 2017; 11: S685–S695. doi: 10.1016/j.dsx.2017.04.026 28483426

5. Thomas M.C., Tsalamandris C., MacIsaac R.J., and Jerums G. The epidemiology of hemoglobin levels in patients with type 2 diabetes. Am J Kidney Dis. 2006a; 48(4): 537–545. doi: 10.1053/j.ajkd.2006.06.011 16997049

6. Abdulrahman H. and Haridas N. Anemia in type 2 diabetes patients with and without nephropathy in Anand-Gujarat, India. International Journal of Advanced Research. 2017; 5(6): 367–374. doi: 10.21474/IJAR01/4421 Available from:

7. Ashkar (El-Achkar) T., Ohmit S.E., McCullough P.A., Crook E.D., Brown W.W., Grimm R., et al. Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney International. 2005; 67(4): 1483–1488. doi: 10.1111/j.1523-1755.2005.00226.x 15780101

8. Baisakhiya S., Garg P., and Singh S. Anemia in patients with type II diabetes mellitus with and without diabetic retinopathy. International Journal of Medical Science and Public Health. 2017; 6(2): 303–306. doi: 10.5455/ijmsph.2017.03082016604

9. Barbieri J., Fontela P.C., Winkelmann E.R., Zimmermann C.E.P., Sandri Y.P., Mallet E.K.V., et al. Anemia in Patients with Type 2 Diabetes Mellitus. Anemia (Hindawi Publishing Corporation). 2015: 1–7. Available from:

10. Feteh V.F., Choukem S.P., Kengne A.P., Nebongo D.N., and Ngowe-Ngowe M. Anemia in type 2 diabetic patients and correlation with kidney function in a tertiary care sub-Saharan African hospital: a cross-sectional study. BMC Nephrology. 2016; 17: 29. doi: 10.1186/s12882-016-0247-1 26994993

11. Gulati M. and Agrawal N. Study of prevalence of anaemia in patients with type 2 diabetes mellitus. Scholars Journal of Applied Medical Sciences. 2016; 4(5F): 1826–1829.

12. He B.B., Xu M., Wei L., Gu Y.J., Han J.F., Liu Y.X., et al. Relationship between Anemia and Chronic Complications in Chinese Patients with Type 2 Diabetes Mellitus. Arch Iran Med. 2015; 18(5): 277–283. doi: 0151805/AIM.005 25959909

13. Hosseini M.S., Rostami Z., Saadat A., Saadatmand S.M., and Naeimi E. Anemia and Microvascular Complications in Patients With Type 2 Diabetes Mellitus. Nephro Urol Mon. 2014; 6(4). doi: 10.5812/numonthly.19976 25695026

14. Ranil P.K., Raman R., Rachepalli S.R., Pal S.S., Kulothungan V., Lakshmipathy P., et al. Anemia and diabetic retinopathy in type 2 diabetes mellitus. J Assoc Physicians India. 2010; 58: 91–94. 20653149

15. Salman M.A. Anemia in patients with diabetes mellitus: prevalence and progression. General Medicine. 2015; 3(1): 162. doi: 10.4172/2327-5146.1000162

16. Sharif A., Younus A., Baig K., and Ali N. Prevalence and risk of anemia in type-2 diabetic patients. Health. 2014; 6: 1415–1419. doi: 10.4236/health.2014.612173

17. Thambiah S.C., Samsudin I.N., George E., Ranjit L.K., Saat N.S., Hussein Z., et al. Anaemia in Type 2 Diabetes Mellitus (T2DM) patients in Hospital Putrajaya. Malaysian Journal of Medicine and Health Sciences. 2015; 11(1): 49–61.

18. Idris I., Tohid H., Muhammad N.A., Rashid M.R.A., Ahad A.M., Ali N., et al. Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study. BMJ Open. 2018; 8. doi: 10.1136/bmjopen-2018-025125 30580276

19. Rathod G.B., Parmar P., Rathod S., and Parikh A. Prevalence of anemia in patients with Type 2 Diabetes Mellitus at Gandhinagar, Gujarat, India. IAIM. 2016; 3(3): 12–16.

20. Panda A.K. and Ambade R.A. Prevalence of anemia and its correlation with HBA1c of patients in type-II diabetes mellitus: a pilot study. Natl J Physiol Pharm Pharmacol. 2018; 8(10): 409–1413.

21. Abate A., Birhan W., and Alemu A. Association of anemia and renal function test among diabetes mellitus patients attending Fenote Selam Hospital, West Gojam, Northwest Ethiopia: a cross-sectional study. BMC Hematology. 2013; 13(1): 6. doi: 10.1186/2052-1839-13-6 24499524

22. Thomas M.C., Cooper M.E., Rossing K., and Parving H.H. Anaemia in diabetes: Is there a rationale to TREAT? Diabetologia. 2006b; 49(6): 1151–1157. doi: 10.1007/s00125-006-0215-6 16586069

23. Bev B. Recognizing anemia in people with diabetes. Association 2009. Available from:

24. Bolen S., Wilson L., Vassy J., Feldman L., Yeh J., Marinopoulos S., et al. Comparative effectiveness and safety of oral diabetes medications for adults with type 2 diabetes. Comparative effectiveness review No. 8. (Prepared by Johns Hopkins Evidence-based practice Center under contract No. 290-02-0018). Rockville, MD: Agency for Healthcare Research and Quality. 2007. Available from:

25. Shams N. and Osmani M.H. Newly diagnosed anemia in admitted diabetics, frequency, etiology and associated factors. J Coll Physicians Surg Pak. 2015; 25(4): 242–246. doi: 04.2015/JCPSP.242246 25899186

26. Jones S.C., Smith D., Nag S., Bilous M.T., and Winship S. Prevalence and nature of anaemia in a prospective, population-based sample of people with diabetes: Teesside Anaemia in Diabetes (TAD) study. Diabet Med. 2010; 27(6): 655–659. doi: 10.1111/j.1464-5491.2010.02987.x 20546283

27. Bonakdaran S., Gharebaghi M., and Vahedian M. Prevalence of anemia in type two diabetic patients and role of renal involvement. Saudi J Kidney Dis Transp. 2011; 22: 286–290.

28. Adejumo B., Dimkpa U., Ewenighi C., Onifade A., Mokogwu A., Erhabor T., et al. Incidence and risk of anemia in type-2 diabetic patients in the absence of renal impairment. Health. 2012; 4: 304–308. doi: 10.4236/health.2012.46050

29. Craig K.J., Williams J.D., Riley S.G., Smith H., Owens D.R., Worthing D., et al. Anemia and diabetes in the absence of nephropathy. Diabetes Care. 2005; 28(5): 1118–1123. Available from: doi: 10.2337/diacare.28.5.1118 15855576

30. Thomas M., Tsalamandris C., Maclsaac R., and Jerums G. Anaemia in diabetes: an emerging complication of microvascular disease. Current Diabetes Reviews. 2005; 1(1): 107–126. doi: 10.2174/1573399052952587 18220587

31. Cusick M., Chew E.Y., Hoogwerf B., Agron E., Wu L., and Lindley A. Risk factors for renal replacement therapy in the Early Treatment Diabetic Retinopathy Study (ETDRS). Early Treatment Diabetic Retinopathy Study Report No. 26. Kidney International. 2004; 66(3): 1173–1179. doi: 10.1111/j.1523-1755.2004.00869.x 15327414

32. Central Statistical Agency (CSA). Central Statistical Agency (CSA) [Ethiopia] and ICF Ethiopia demographic and health Survey. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF. 2016. Available from:

33. Shaw J.E., Sicree R.A., and Zimmet P.Z. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice. 2010; 87: 4–14. doi: 10.1016/j.diabres.2009.10.007 19896746

34. National Nutrition Program-II (NNP-II). Government of the Federal Democratic Republic of Ethiopia National Nutrition Programme (NNP) 2016–2020. NNP Implementing Sectors’ Declaration. 2016. Available from:…/eu_joint_strategy_on_nutrition_for_ethiopia_2016-2020_1.pdf.

35. Solomon A., Hussein M., Negash M., Ahmed A., Bekele F., and Kahase D. Effect of iron deficiency anemia on HbA1c in diabetic patients at Tikur Anbessa specialized teaching hospital, Addis Ababa, Ethiopia. BMC Hematology. 2019; 19(2). doi: 10.1186/s12878-018-0132-1 30647919

36. Central Statistical Agency (CSA). Report on the population and housing census of Ethiopia: Addis Ababa, Ethiopia. 2007. Available from:

37. Central Statistical Agency (CSA) and World Food Program (WFP). Comprehensive Food Security and Vulnerability Analysis (CFSVA) of Ethiopia. 2019. Available from: and

38. Maria P. and Evagelia S. Obesity disease. Health Science Journal. 2009; 3(3): 132–138.

39. Tolonen H., Kuulasmaa K., Laatikainen T., and European Health Risk Monitoring Project. European Health Risk Monitoring (EHRM). National Public Health Institute Recommendation for indicators, international collaboration, protocol and manual of operations for chronic disease risk factor surveys. 2002. Available from:

40. WHO. Waist circumference and waist-hip ratio: Report of a WHO Expert Consultation Geneva. 2008b. Available from:

41. Guerra R.S., Amaral T.F., Marques E.A., Mota J., and Restivo M.T. Anatomical location for waist circumference measurement in older adults: a preliminary study. Nutr Hosp. 2012; (5): 1554–1561. doi: 10.3305/nh.2012.27.5.5922 23478705

42. Kearney P.M., Whelton M., Reynolds K., Muntner P., Whelton P.K., and He J. Global burden of hpertension: analysis of worldwide data. The Lancet. 2005; 365(9455): 217–223.

43. Ranasinghe P., Cooray D.N., Jayawardena R., and Katulanda P. The influence of family history of Hypertension on disease prevalence and associated metabolic risk factors among Sri Lankan adults. BMC Public Health. 2015; 15(576): 1–9. doi: 10.1186/s12889-015-1927-7 26092387

44. Bayisa B. and Bekele M. Glycemic control and associated factors among type II diabetic patients on chronic follow up at Southwest Ethiopia. Journal of Medical and Health Sciences. 2017; 6(3): 341–349.

45. Colberg S.R., Sigal R.J., Yardley J.E., Riddell M.C., Dunstan D.W., Dempsey P.C., et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016; 39(11): 2065–2079. doi: 10.2337/dc16-1728 27926890

46. Mehdi U. and Toto R.D. Anaemia, diabetes, and chronic kidney disease. Diabetes Care. 2009; 32(7): 1320–1326. doi: 10.2337/dc08-0779 19564475

47. Katroth A., Narayanam A., Chauhan S., and Singh A. Diabetes mellitus and metformin: fatal vitamin B12 deficiency associated with anemia and sepsis in a young adult. Journal of Applied Pharmaceutical Science. 2018; 8(3): 165–167. doi: 10.7324/JAPS.2018.8322 Available from:

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden