Genetic disposition and modifiable factors independently associated with anemia in patients with type 2 diabetes mellitus

Terry Ting Yu Chiou, Jong Jer Lee, Ming Chung Wang, Min Shien Chung, Lin Lin Pan, Ching Jung Hsieh, Siang Ting Huang, Hsueh Wen Chang, Kuender D. Yang, Chien Te Lee, Rue Tsuan Liu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

6 Scopus citations


Aims: Anemia is prevalent but under-recognized in patients with diabetes mellitus (DM). Genetic variants in angiotensin-converting enzyme (ACE), tumor necrosis factor-alpha (TNF-α) and erythropoietin (EPO) have been associated with diabetic nephropathy. In the present study, we investigated the associations between anemia and polymorphisms in EPO promoter (rs1617640), TNF-α G-308A and ACE Insertion/Deletion in Chinese patients with type 2 diabetes. Methods: Polymorphisms in ACE, TNF-α and EPO were genotyped in 1142 patients. Anemia was defined as hemoglobin (Hb) levels below 12. g/dL for women and 13. g/dL for men. Results: 286 (25%) patients had anemia. Patients with anemia were older, had longer duration of diabetes, worse renal function and more albuminuria. ACE Insertion/Deletion and TNF-a G-308A were not associated with anemia. The frequencies of EPO polymorphism (rs1617640) were significantly different between anemic and nonanemic patients. Patients with TT genotype had higher prevalence of anemia than those with TG and GG. Regression analysis identified EPO SNP, duration of DM, serum albumin, albuminuria and renal function independently associated with anemia. After adjusting for multiple variables, TT and TG genotypes were associated with 3-5-fold increased risk for anemia compared to GG. Conclusions: The EPO genotype in Chinese patients with type 2 diabetes is associated with anemia and may help to identify those at risk. Further evaluation of its effect on clinical outcomes in prospective studies may be useful to predict the outcomes of erythropoiesis stimulating therapy, and to individualize anemia management.

Original languageEnglish
Pages (from-to)164-169
Number of pages6
JournalDiabetes Research and Clinical Practice
Issue number1
StatePublished - 01 04 2015

Bibliographical note

Publisher Copyright:
© 2015 Elsevier Ireland Ltd.


  • Anemia
  • EPO gene polymorphism
  • Type 2 diabetes mellitus


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