Erythropoietin depletion and anaemia in diabetes mellitus

Summary Aims To discover 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‐COMP) were selected because of severe symptomatic autonomic neuropathy, including significant postural hypotension. All had proteinuria from nephropathy (three microalbuminuria and 12 macroalbuminuria), but a normal serum creatinine (< 122 μmol/l). They were compared to age and duration matched Type 1 diabetic controls without autonomic neuropathy (DM‐controls) and non‐diabetic 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 non‐neuropathic 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 the progressive increase in the non‐diabetic, anaemic patients (difference of regression lines P < 0.001), indicating EPO depletion in the anaemic, diabetic patients. There was no other demonstrable cause for the anaemia. Treatment with EPO in 5 DM