Iron Deficiency Anemia in Children and Adolescents with Type 1 diabetes, is it a Real Problem?

Abstract

ron deficiency anemia a prevalent finding in patients with type 1 diabetes and represents a significant unrecognized burden. In this study, the aim was triple; to study prevalence of iron deficiency anemia among type 1 diabetic children and adolescents, to identify possible etiologies of iron deficiency anemia, and to correlate parameters to glycemic control. This cross-sectional study included two hundred children and adolescents with type 1diabetes who were recruited from Pediatrics and Adolescent Diabetology Unit (PADU), Ain Shams University in the period from December 2019 to July 2020. Participants were 123 males (61.55%) and 77 females (38.5%) with type 1 diabetes. Their mean age was 10.97 ± 3.93 years (range: 2– 18 years). Patients were subjected to full history taking; general examination laying stress on pallor and anthropometric measurements, fundus examination and laboratory evaluation including complete blood count, glycosylated hemoglobin (HbA1c), lipid profile, Serum iron, total iron-binding capacity (TIBC), and serum ferritin. Patients with microcytic hypochromic anemia underwent assessment of occult blood in stool, Anti-tissue trans-glutaminase (IgA), H-pylori antigen in stool, and serum Hepcidin level. Our results revealed that 46% (92/200) of diabetic patients were anemic and 25.5% (51/200) of them were having iron deficiency anemia. Upon comparison of patients with IDA to those without anemia, they were younger, and with long duration of diabetes, they showed higher frequency of hypoglycemic and/or DKA attacks, menorrhagia in adolescent females and fatigue severity scale. Males were affected more than females. Also, patients were having higher HbA1c, low BMI. Micro vascular complications were more frequent among those with IDA. Patients with non-microcytic anemia should have further investigations to identify the cause of anemia. One of the limitations of our study was that a case control study design was used so that the causality between iron deficiency anemia and T1D could not be established; just the association between them could be suggested.