Erythropoietin depletion and anaemia in diabetes mellitus

Aims To dissever whether Type 1 diabetic patients with autonomic neuropathy might be anaemic and erythropoietin (EPO)-depleted. Methods Fifteen Type 1 diabetic patients with serious complications (DM-COM P) were selected because of severe symptomatic autonomic neuropathy, includ ing significant postural hypotension. All had proteinuria from nephropathy (three microalbuminuria and 12 macroalbuminuria), but a normal serum creati nine (<122 mu mol/l). They were compared to age and duration matched Type 1 diabetic controls without autonomic neuropathy (DM-controls) and non-diabe tic patients with and without hypochromic, microcytic anaemia. Results The DM-COMP patients were anaemic (mean haemoglobin (Hb) 11.1 +/- 1 .2 g/dl), sometimes severely (minimum Hb 9.2 g/dl), compared to nonneuropat hic DM-controls (Hb 13.7 +/- 0.7 g/dl; P < 0.001). Furthermore, EPO failed to increase in association with anaemia in the DM-COMP group compared to th e progressive increase in the non-diabetic, anaemic patients (difference of regression lines P < 0.001), indicating EPO depletion in the anaemic, diab etic patients. There was no other demonstrable cause for the anaemia. Treat ment with EPO in 5 DM-COMP patients led to a rapid increase in haemoglobin (range 1.7-5.0 g/dl) with improvement in wellbeing. Conclusion Some Type 1 diabetic patients with autonomic neuropathy present with an EPO-depleted anaemia, which responds to treatment with EPO. This ob servation supports the concept of autonomic neuropathy as a cause of anaemi a with EPO depletion, although the role of established renal damage cannot be excluded.