The erythropoietin dysregulation, caused by early damage to renal tubules, has been suggested as one of contributors to anemia in patients with diabetes.[23–27] Moreover, nutrient deficiencies, inflammation, concomitant autoimmune disease, drugs and hormonal changes might contribute to anemia in patients with diabetes.[28, 29] The mechanisms by which low hemoglobin concentration might contribute to the progression or development of albuminuria in patients with type 2 diabetes are unclear. This evidence concerns the gene EPO and autoimmune disease.