Clinical Nutrition Open Science (Oct 2022)
Cross-link between type 2 diabetes mellitus and iron deficiency anemia. A mini-review
Abstract
Summary: Introduction: Type 2 diabetes mellitus (T2DM) is implicated in development of various comorbidities and complications, including iron deficiency anemia (IDA). However, the exact mechanisms have not been properly documented. This review sought to highlight the interlink between T2DM and the development of iron deficiency anemia. Methods and analysis: Two independent researchers searched the literature on MEDLINE. About 33 studies were retrieved, however, only 15 were deemed relevant to this review. Data drawn from each study was critically evaluated, and personal viewpoints were made from the results. Results: According to the evidence summarized in this review, shows T2DM patients have an increased risk of developing IDA. Moreover, suggests that chronic inflammation due to the aberrant activation of pro-inflammatory cytokines (interleukin-6, 8, tumor necrosis factor-alpha, and interferon-gamma), are central to the development of IDA. Other hypothesized mechanisms for iron deficiency include impaired erythropoietin production and release from the kidney and elevated hepcidin levels in the liver. Anemia is driven on by the direct reduction in red blood cell survival mediated by pro-inflammatory cytokines. Similarly, iron deficiency in T2DM increases the levels of angiogenic factors (vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), hepatocyte growth factor (HGF), platelet-derived growth factor and hypoxia-inducible factor-1α (HIF-α)) and ultimately anemia. Additionally, iron and pro-inflammatory cytokines induce oxidative stress, which results in endothelial dysfunction and subsequent imbalance in angiogenic factors and ultimately anemia. Conclusion: The association between T2DM, IDA, and angiogenic factors is highlighted in this review however, future research is required to derive conclusive evidence.
