& Hyperglycemia and Iron Deficiency on Kidney and Heart Function in Type 2 Diabetes Disease

Untreated anemia can caused significant cardiac and kidney damage. The aim of this study was to investigate the efficiency of anemia and hyperglycemia treatment in type  diabetes and their impact on kidney and heart impairment. The study is clinical retrospective and prospective and it was conducted in Clinic of Endocrinology, Diabetes Mellitus and Metabolic Diseases , University Clinical Center of Sarajevo. Prior to the study all patients were taking oral hy-poglycemic drugs included sulfonylureas and biguanides. These subjects were put on  times daily fix mix insulin and biguanides after lunch. Each day, subjects received Iron tab x mg/ day, and C vitamin x mg/day. The results of our study are showing that effective treatment of glycaemia and anemia in patients with diabetes, reduces blood pressure, urine albumin secretion and pulse rate, diminishing cardiovascular damage and improving kidney function.


Introduction
Anemia is associated with macrovascular morbidity.People with diabetes have suffered from anemia for a number of years before receiving treatment.Untreated anemia can caused significant cardiac and kidney damage.Heart has to work harder to pump blood around the body due to the limited amount of oxygen -carrying hemoglobin through the blood stream, what can deteriorate a high risk of coronary heart disease in people with type  diabetes (, , , ).Patients with chronic kidney disease and anemia experience an  increased risk of stroke compared to patients without chronic kidney disease.Anemia therapy in patients with heart failure may reduce the risk of subsequent hospitalization, and anemia therapy in patients with chronic kidney disease not on dialysis may reduce the risk of progression of chronic kidney disease (,).

Objective
Our aim was to investigate the efficiency of anemia and hyperglycemia treatment in type  diabetes and their impact on kidney and heart impairment.

Patients and Methods
This study was conducted in Clinic of Endocrinology, Diabetes Mellitus and Metabolic Diseases, University Clinical Center of Sarajevo.Thirty subjects with type  diabetes were enrolled in this study, during  weeks.There were treated in outpatients department of the hospital.Prior to the study all patients were taking oral hypoglycemic drugs included sulfonylureas and biguanides.These subjects were put on  times daily fix mix insulin and biguanides after lunch.Each day, subjects received Iron tab x mg/ day, and C vitamin x mg/day.HbAc levels, BMI, Hct, Hgb, MCH, urine albumin secretion (after  h of rest ,  urine samples, urine was sterile, in non-ketotic patients (ketostix reaction less than ++), blood pressure, pulse rate were monitored prior and after  -week study.Criteria of good diabetes control were done by using fasting blood sugar (, -, mmol/l), urinary sugar negative, urine albumin secretion negative, HbAc <, blood pressure < / mmHg, Hct (, -, L/L) Hgb(- g/l) MCH (, -, pg), serum iron.These subjects were put on  times daily fix mix insulin and biguanides after lunch.

Results
Prior to the study these subjects had mean HbAc level ,, BMI , kg/m and Hct , L/L, Hb , g/l, MCH , pg, mean albumin secretion in urine , g/dl (after  h of rest ,  urine samples, urine was sterile, in non-ketotic patients (ketostix reaction less than ++) mean blood pressure ,/, mmHg and mean pulse rate /min.After  weeks of switching subjects on insulin and biguanides therapy, and receiving Irons tablets, mean HbAc level was significantly reduced (p< ,) to ,  (S.D.= ,), BMI was decreased to , kg/ m ( S.D.= ,), mean blood pressure was significantly reduced (p < ,) to ,/, mmHg ( S.D.= ,) and urine albumin secretion was significantly reduced (p< ,) to ,g/dl ( S.D.= ,).HCT , L/L (S.D. ,) p< ,, Hgb ,, (S.D.= ,) p<, and MCH , (S.D.= ,) levels were improved.Patients stop to complained of tiredness and depression.Mean pulse rate was improve to /min.For statistical analyses we used student T -test to prove significant differences with p < ,, comparing parameters prior and after the study.

Discussion
The erythrocyte function is to deliver oxygen to the tissue, so the main consequence of anemia is tissue hypoxia.Anemia may be an independent predictor of adverse cardiovascular events.Anemia is a common consequence of chronic kidney disease.Chronic kidney disease and anemia have independent pathways through which they lead to elevate risk of macrovascular events (, , ,  ).Anemia is associated with myocardial ischemia, although it is not known whether anemia also facilitates cerebral ischemia.In the heart, pathophysiologic adaptations associated with anemia can lead to left ventricular hypertrophy in the long -term, especially when they take place in the presence of chronic kidney disease.(, , , , ) During the treatment of diabetic patients at the Clinic of Endocrinology, diabetes mellitus and metabolic diseases in Sarajevo, we noticed a big number of patients with anemia.We decided to follow up above mentioned parameters in this population before and after treatment of anemia.After three months of treatment we improved glycaemia control, the values of hemoglobin, hematocrit, blood pressure and urine albumin secretion rate.Mean pulse rate was improved.We observed that patients stop to complained of tiredness and depression.

References Conclusion
People with diabetes type  should be checked and appropriately treated for anemia in early stage of the disease.Effective treatment of glycaemia and anemia in patients with diabetes, reduces blood pressure, urine albumin secretion and pulse rate, diminishing cardiovascular damage and improving kidney function.
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