AbstractAims The aim of this study was to investigate the therapeutic effect of recombinant human erythropoietin (rHuEpo) on anaemia with erythropoietin deficiency in diabetic patients.Methods Twenty diabetic patients with anaemia and Epo deficiency were enrolled. All patients were treated with rHuEpo (Epokine®; 4000 U/day s.c., three times a week) for 8 weeks.Results The responder group (n = 14) had significant increments in haemoglobin compared with the non‐responder group (n = 6) (P < 0.05). No significant differences were found between the responder and non‐responder groups in terms of duration of diabetes mellitus, serum creatinine level, 24‐h urine albumin excretion rates, frequency of diabetic microangiopathy, or HbA1c. There was no difference between the two groups in terms of serum iron and total iron‐binding capacity (TIBC). Serum ferritin level was significantly higher in the responder group than in the non‐responder group (240.3 ± 108.4, 25.8 ± 3.0 µg/l, P < 0.05), as was transferrin saturation (32.7 ± 7.9%, 21.2 ± 5.3%, P < 0.05).Conclusions rHuEpo could be useful in the treatment of anaemia with erythropoietin deficiency in diabetic patients, and the degree of iron storage and functional iron deficiency might be the main cause of hyporesponsiveness to rHuEpo.