Mean platelet volume and platelet counts in type 2 diabetes: mellitus on treatment and non-diabetic mellitus controls in Lagos, Nigeria

Changes in Haematological Parameters and Lipid Profiles in Diabetes Mellitus: A Literature Review

Diabetes mellitus is a metabolic disorder characterized by elevated blood glucose that has sequelae on cellular, haematological, and metabolic parameters, including lipid profile disturbed homeostasis, which manifest in alterations in haematological parameters and lipid profiles. These changes in haematological parameters and lipid profiles have been reported by previous research; however, the pattern of these changes and their correlation have not been elucidated. This review aims to assess these changes and investigate the degree of correlation between haematological parameters and lipid profiles in patients with type 2 diabetes mellitus (T2DM). The method adopted was a traditional review approach that included a narrative of concepts and a critical assessment of a few selected articles. Findings highlight that haematological parameters and lipid profiles show varied alterations and correlations in T2DM. For instance, statistical significances at p < 0.05 are reported for WBC count (r = -0.75) showing negative correlations (p < 0.001), where RBC count (r = 0.56) showed correlation with high-density lipoprotein cholesterol (HDLC), whereas anaemia (packed cell volume: r = -0.51) and RBC indices (mean corpuscular volume: r = -0.75; mean corpuscular haemoglobin: r = -089) show negative correlations with total cholesterol (TC). The specific haematological parameters, namely, RBC and WBC with differential and platelet counts, as well as indices, showed varied changes and correlation with lipid profiles, namely, HDLC, low-density lipoprotein cholesterol, TC, and triglyceride, in the six reviewed articles. Diabetes is characterized by changes in haematological parameters and lipid profiles. A better understanding of the negative and positive correlating changes could be utilized in routine evaluation of subjects with prediabetes as well as managing complications in diabetes. Correlation between haematological parameters and lipid profiles over the course of diabetes progression using HbA1c as an index of glucose control is necessary for additional empirical data and updates.

Predicting the dynamics of organ failure in patients with acute pancreatitis depending on the mean platelet volume

Background

The aim of this study is to determine the correlation between the blood serum mean platelet volume (MPV) and the dynamics of the OF course during the early phase in patients with moderately severe and severe acute pancreatitis (AP).

Methods

The predetermined criterion was the presence of the OF according to the revised Atlanta criteria 2012 for moderately severe and severe AP. A prospective sample of patients was stratified by severity, and two groups were defined based on MPV. Demographic indicators, comorbidities and clinical outcomes were compared between these groups. Multifactorial analysis determined whether an elevated MPV is independently associated with early OF and other unfavorable outcomes.

Results

Out of 108 patients, 20 had moderately severe AP and 88 had severe AP. The blood serum MPV, measured within 72 h of the onset of AP symptoms was lower 11.8 fL in 32 patients and equal to or greater 11.8 fL in 76 patients. Patients with elevated MPV were older (63 vs. 48 years), had obesity (59.2 % vs. 25 %), diabetes mellitus (DM) (51.3 % vs. 12.5 %), ischemic heart disease (70.8 % vs. 28.1 %) and more frequently experienced persistent OF (93.4 % vs. 53.1 %) compared to those with MPV lower 11.8 fL. The incidence of early OF increased proportionally with the severity of MPV (81.6 % vs. 34.4 % in the group with MPV lower 11.8 fL, Ptrend < 0.0001). In multifactorial analysis, adjusted for body mass index and DM, MPV equal to or greater 11.8 fL was independently associated with early OF.

Conclusions

Elevated blood serum MPV of patients with AP are independently and proportionally correlated with early organ failure in patients with alcoholic and idiopathic etiology of AP.

Key message

The study provides an evaluation of MPV as a prognostic marker for organ failure within the initial 7 days following the onset of acute pancreatitis symptoms. Additionally, alterations in MPV were identified in patients with acute pancreatitis who had diabetes or ischemic heart disease within the first 24 h of hospitalization.

Assessment of Erythrocyte Osmotic Fragility and Its Determinants, and Comparison of Hematological Indices Among Type 2 Diabetes Mellitus Patients on Follow-Up at Jimma Medical Center, Southwest Ethiopia

Background

Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases worldwide. Approximately 9.3% of the general population was estimated to have DM globally in 2019. Erythrocyte osmotic fragility (EOF) in hyperglycemic patients is expected to increase and determine the rate of erythrocyte hemolysis.

Purpose

This study aimed to assess erythrocyte osmotic fragility (EOF) and its determinants and to compare hematological indices among T2DM patients on follow-up at the Jimma Medical Center (JMC), Jimma, Southwest Ethiopia.

Methods

A facility-based cross-sectional study involving 124 participants (each 62) of T2DM patients and controls was conducted from October to November 2020 using a structured questionnaire. 5 mL of venous blood was drawn to assess OF, complete blood count, and blood glucose levels. EOF was investigated using a series hypotonic solution of NaCl. The supernatant of the centrifuged sample was transferred to cuvette test tubes, and the hemolysis stage was read on a spectrophotometer. The collected data were coded and entered into Epi-data Version 3.1. The analysis was performed using SPSS Version 23.

Results

Compared with non-diabetic controls, patients with T2DM had significantly increased EOF. FBG >126mg/dl (AOR=7.741, 95% CI: 1.562-38.360), PPBG >200 mg/dl (AOR=7.576, 95% CI: 1.519-37.791), RDW (AOR=4.558, 95% CI: 1.136-18.284) were significantly associated with abnormal EOF. A statistically significant increase in total white blood cells and absolute neutrophil counts (P < 0.001) were observed in T2DM patients. From RBC indices, red blood cell distribution width (RDW) and mean corpuscular volume (MCV) were significantly increased in T2DM patients (P < 0.001).

Conclusion

This study suggests that EOF was greater in patients with T2DM than in non-diabetic controls and was determined by FBG, PPBG, and RDW. The study also demonstrated that hematological index alterations were higher in T2DM subjects than in non-diabetic controls.

Complete blood count inflammation derived indexes as predictors of metabolic syndrome in type 2 diabetes mellitus

BACKGROUND

Metabolic syndrome (MetS) is a group of comorbidities related to regulating hyperglycemia and acute cardiovascular incidents and complications. With the increasing prevalence in individuals with type 2 diabetes mellitus (T2DM), MetS represents an increasing public health problem and clinical challenge, and early diagnosis is necessary to avoid the accelerated development of diabetic complications.

OBJECTIVE

To investigate the role of Complete Blood Count-derived Inflammation Indexes (CBCIIs) in predicting MetS in T2DM individuals.

METHODS

The study was designed as a two-year prospective study and included 80 T2DM individuals divided into MetS and non-MetS groups based on MetS development over two years. The sera samples were analyzed for complete blood count parameters and C-reactive protein (CRP). Based on the laboratory test results, 13 CBCIIs were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy.

RESULTS

There were significant differences between T2DM participants with Mets and those without MetS concerning Neutrophil to Platelet Ratio (NPR) values (p< 0.001), Neutrophil to Lymphocyte and Platelet Ratio (NLPR) (p< 0.001), Platelet to Lymphocyte Ratio (PLR) (p< 0.001), Lymphocyte to C-reactive protein Ratio (LCR) (p< 0.001), C-reactive protein to Lymphocyte Ratio (CRP/Ly) (p< 0.001), Systemic immune inflammation index (SII) (< 0.001), and Aggregate Index of Systemic Inflammation (AISI) (p= 0.005). The results of ROC curve analysis have shown that the LCR (AUC of 0.907), CRP/Ly (AUC of 0.907) can serve as excellent predictors, but NPR (AUC of 0.734), NLRP (AUC of 0.755), PLR (AUC of 0.823), SII (AUC of 0.745), and AISI (AUC of 0.688) as good predictors of MetS in T2 DM individuals.

CONCLUSION

This study confirms the reliability of the CBCIIs as novel, simple, low cost and valuable predictors of MetS developing in T2DM.

Counteractive role of Terminalia catappa leaf extract on hematological and coagulation disturbance in Type 2 diabetic rats

Background and Aim

Diabetes mellitus is a leading cause of mortality worldwide associated with hyperglycemia-induced hematological aberrations and thromboembolic complications. This study aimed to explore the modulatory effect of Terminalia catappa leaf aqueous crude extract (TCLE) on hematological and coagulation disturbances in a Type 2 diabetic rat model.

Materials and Methods

High-fat diet streptozotocin-induced diabetic rats were treated orally with 400 and 800 mg/kg body weight TCLE daily for 28 days. Full blood count, coagulation parameters, plasma calcium (Ca), and erythrocyte glycogen (GLYC) levels were assessed using standard procedures.

Results

Terminalia catappa leaf aqueous crude extract treatment had a significant (p < 0.05) prolonging effect on clotting and bleeding times while increasing Ca, GLYC and mean corpuscular volume in diabetic rats. On the other hand, lymphocytes (LYM), platelet (PLT) count, mean PLT volume, neutrophil-LYM ratio (NLR), and PLT-LYM ratio (PLR) of TCLE-treated diabetic animals were significantly reduced (p < 0.05) compared with untreated diabetic animals. Lymphocyte, PLT count, NLR, and PLR correlated positively (p < 0.05) with plasma glucose, while a significant positive association was observed between Ca and GLYC. On the other hand, a strong negative association (p < 0.05) was observed between clotting time and fasting plasma glucose.

Conclusion

These findings suggest that T. catappa leaf extract may be useful in reversing diabetic-mediated hematological anomalies due to its anticoagulant and anti-anemic activities.

Quality of glycemic control in type 2 diabetes mellitus (T2DM) and its association with markers of coagulation and inhibitors of fibrinolysis: A case-control study in the Upper West Region, Ghana

Background and Aims

Type 2 diabetes mellitus (T2DM) individuals are at a higher risk of developing diabetes complications, with approximately 80% complication-related mortality. The increased morbidity and mortality among T2DM patients are partly due to dysregulated hemostasis. This study determined the quality of glycemic control in T2DM and its association with markers of coagulation and inhibitors of fibrinolysis.

Methods

This case-control study recruited 90 participants involving: 30 T2DM patients with good glycemic control, 30 with poor glycemic control, and 30 nondiabetic subjects as controls at a Municipal Hospital in Ghana. Fasting blood glucose, glycated hemoglobin, activated partial thromboplastin time (APTT), prothrombin time (PT), calculated international normalized ratio (INR), and full blood count (FBC) were determined for each respondent. Plasma levels of plasminogen activator inhibitor-1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI) were determined using the solid-phase sandwich enzyme-linked immunosorbent assay method. Data were analyzed using R language software.

Results

Plasma PAI-1 antigen levels were significantly higher in the participants with poor glycemic control as compared to participants with good glycemic control (p < 0.0001). There was no significant difference in plasma TAFI levels between the participants with poor glycemic control as compared to participants with good glycemic control (p = 0.900). T2DM patients had significantly shorter APTT, PT, and INR than controls (p < 0.05). At a cut-off of ≥161.70 pg/μL, PAI was independently associated with increasing odds (adjusted odds ratio = 13.71, 95% confidence interval: 3.67-51.26, p < 0.0001) of poor glycemic control and showed the best diagnostic accuracy for poor glycemic control (area under the curve = 0.85, p < 0.0001).

Conclusion

PAI-1 levels were significantly increased in T2DM with poor glycemic control and emerged as the best predictor for poor glycemic control. Good glycemic management to control the plasma levels of PAI-1 is required to prevent hypercoagulability and thrombotic disorders.

Risk Factors of Hyperglycemia After Treatment With the AKT Inhibitor Ipatasertib in the Prostate Cancer Setting: A Machine Learning-Based Investigation

PURPOSE

Hyperglycemia is a major adverse event of phosphatidylinositol 3-kinase/AKT inhibitor class of cancer therapeutics. Machine learning (ML) methodologies can identify and highlight how explanatory variables affect hyperglycemia risk.

METHODS

Using data from clinical trials of the AKT inhibitor ipatasertib (IPAT) in the metastatic castrate-resistant prostate cancer setting, we trained an XGBoost ML model to predict the incidence of grade ≥2 hyperglycemia (HGLY ≥ 2). Of the 1,364 patients included in our analysis, 19.4% (n = 265) of patients had HGLY ≥2 events with a median time of first onset of 28 days (range, 0-753 days), and 30.0% (n = 221) of patients on an IPAT regimen had at least one HGLY ≥2 event compared with 7.0% (n = 44) of patients on placebo.

RESULTS

An 11-variable XGBoost model predicted HGLY ≥2 events well with an AUROC of 0.83 ± 0.02 (mean ± standard deviation). Using SHapley Additive exPlanations analysis, we found IPAT exposure and baseline HbA1c levels to be the strongest predictors of HGLY ≥2, with additional predictivity of baseline measurements of fasting glucose, magnesium, and high-density lipoproteins.

CONCLUSION

The findings support using patients' prediabetic status as a key factor for hyperglycemia monitoring and/or trial exclusion criteria. Additionally, the model and relationships between explanatory variables and HGLY ≥2 described herein can help identify patients at high risk for hyperglycemia and develop rational risk mitigation strategies.

Role of hematological parameters in pathogenesis of diabetes mellitus: A review of the literature

Diabetes mellitus (DM) is characterized by hyperglycemia and abnormalities in insulin secretion and activity. There are numerous hematological parameters; however, this review article only focuses on red blood cells, hemoglobin, hematocrit, red blood cell indices, platelet count, white blood cells, lymphocytes, neutrophils, monocytes, eosinophils, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio, which play an essential role in the pathogenesis of DM. Also, this review article aims to report the relationship between these hematological parameters and the development of DM. In con-clusion, this article shows that increased levels of platelets, red blood cells, hematocrit, lymphocytes, eosinophils, neutrophils, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio and decreased levels of hemoglobin are involved in the pathogenesis of DM. However, the role of basophils in DM is unknown yet.

Prediction of type 2 diabetes mellitus using hematological factors based on machine learning approaches: a cohort study analysis

Type 2 Diabetes Mellitus (T2DM) is a significant public health problem globally. The diagnosis and management of diabetes are critical to reduce the diabetes complications including cardiovascular disease and cancer. This study was designed to assess the potential association between T2DM and routinely measured hematological parameters. This study was a subsample of 9000 adults aged 35-65 years recruited as part of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. Machine learning techniques including logistic regression (LR), decision tree (DT) and bootstrap forest (BF) algorithms were applied to analyze data. All data analyses were performed using SPSS version 22 and SAS JMP Pro version 13 at a significant level of 0.05. Based on the performance indices, the BF model gave high accuracy, precision, specificity, and AUC. Previous studies suggested the positive relationship of triglyceride-glucose (TyG) index with T2DM, so we considered the association of TyG index with hematological factors. We found this association was aligned with their results regarding T2DM, except MCHC. The most effective factors in the BF model were age and WBC (white blood cell). The BF model represented a better performance to predict T2DM. Our model provides valuable information to predict T2DM like age and WBC.

Association of platelet count and plateletcrit with nerve conduction function and peripheral neuropathy in patients with type 2 diabetes mellitus

AIMS/INTRODUCTION

Diabetes has been considered as a 'pro-thrombotic state' with enhanced platelet reactivity. Abnormality in platelet aggregation has been found in patients with its most common chronic complication - diabetic peripheral neuropathy (DPN). The purpose of this study was to investigate the potential association of platelet indices with nerve conduction function and the presence of DPN in Chinese patients with type 2 diabetes mellitus.

MATERIALS AND METHODS

This study involved a total of 211 inpatients with type 2 diabetes mellitus and 55 healthy individuals for whom nerve conduction studies were carried out. DPN was diagnosed according to the American Diabetes Association recommendation. Clinical data were retrospectively collected.

RESULTS

Patients with diabetes in whom neuropathy developed had lower levels of platelet count (PLT) and plateletcrit (PCT) than healthy controls (P < 0.05). Statistically significant associations of low PLT and PCT levels with the reduction of summed amplitude/velocity Z-score, and the prolongation of F-wave minimum latency in nerve conduction studies were found. Furthermore, after multivariate adjustment, logistic regression analysis showed that low levels of PLT (odds ratio 2.268, 95% confidence interval 1.072-4.797; P < 0.05; PLT <226 vs PLT ≥226) and PCT (odds ratio 2.050, 95% confidence interval 1.001-4.201; P < 0.05; PCT <0.222 vs PCT ≥0.222) in type 2 diabetes mellitus patients were risk factors for the presence of DPN.

CONCLUSIONS

Lower PLT and PCT levels are closely associated with poorer peripheral nerve conduction functions and the presence of neuropathy in patients with type 2 diabetes mellitus, which suggests that PLT and PCT might be potential biomarkers for showing DPN.

Hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia: A comparative cross-sectional study

BACKGROUND

Diabetes is a global public health problem and associated with metabolic, cellular, and blood disturbances. Hematological changes have been reported in diabetes and play a major role in diabetes-associated complications. However, reports are contradicting and data on hematological parameters of type 2 diabetic patients in the study area are scarce. Therefore, the aim of this study was to assess the hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia from May 01 to June 30, 2020.

METHODS

A comparative cross-sectional study was conducted on 268 (134 type 2 diabetic patients and 134 controls) study participants selected by systematic random sampling technique. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire and checklist. Ethical approval was obtained from Jimma University. All phase of quality assurance was maintained. Hematological parameters and blood glucose levels were determined using UniCel DxH 800 (Beckman Coulter, USA) and Biosystems A25 (Costa Brava, Spain) analyzers, respectively. Independent t-test, Mann-Whitney U-test, correlation, and logistic regression were used during data analysis. P-value <0.05 was considered as statistically significant.

RESULTS

The current study found that total white blood cell count, absolute counts of neutrophil, lymphocyte, eosinophil, and basophil, red blood cell distribution width, platelet count, and mean platelet volume were significantly higher in type 2 diabetic patients as compared to the control group (P<0.05). On the other hand, the mean hemoglobin was significantly lower in type 2 diabetic patients than the control group (P = 0.007). Anemia was found in 17.9% of type 2 diabetic patients. Longer duration of diabetes (AOR = 3.05, 95% CI = 1.12-8.34) and milk consumption (AOR = 4.60, 95% CI = 1.50-14.00) were significantly associated with anemia.

CONCLUSION

This study showed a statistically significant variation in some hematological parameters of type 2 diabetic patients compared to control group. Anemia among type 2 diabetic patients was found to be a mild public health problem. Therefore, routine screening of hematological parameters should be considered for proper management of type 2 diabetic patients. Close attention should also be given to the duration of diabetes and dietary practice.

First-Trimester Platelet Count as a Predictive Biomarker for Neonatal Birth Weight Among Pregnant Women at Advanced Maternal Age

The aim of this study was to investigate the association between first-trimester platelet count and neonatal birth weight in pregnant woman at advanced maternal age. Our study included 148 pregnancy women of advanced maternal age, the clinical and laboratory materials were retrospective obtained from medical record system. The neonatal birth weight was positively correlated with maternal body mass index and fetus gestational age (r = 0.332, P < .001; r = 0.469, P < .001), even more interestingly, the neonatal birth weight was positively correlated with first-trimester platelet count in pregnant women of advanced maternal age (r = 0.203, P = .013). Multiple linear regression analysis revealed that neonatal birth weight had an independently association with first-trimester platelet count in pregnant women of advanced maternal age (multiple-adjusted r values 0.167, P = .013). First-trimester platelet count is positively associated with neonatal birth weight, suggesting that first-trimester platelet count may be a predictive biomarker for neonatal birth weight in pregnant women of advanced maternal age.

Basic Coagulation Profiles and Platelet Parameters Among Adult Type 1 and Type 2 Diabetes Patients at Dessie Referral Hospital, Northeast Ethiopia: Comparative Cross-Sectional Study

BACKGROUND

Diabetes is a heterogeneous group of metabolic disorders characterized by hyperglycemia. The disease is highly associated with micro-vascular and macro-vascular complications. Thus, the main aim of this study was to compare basic coagulation profiles and platelet parameters among type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and healthy controls.

METHODS

A comparative cross-sectional study was conducted at Dessie Referral Hospital from February to April 2019. A total of 180 study participants consisting of (60 T1DM, 60 T2DM, and 60 healthy controls) were enrolled using a systematic random sampling technique. Basic coagulation profiles and platelet parameters were determined using the HUMACLOT JUNIOR coagulometer and DIRUI BF 6500 automated hematology analyzer respectively. Non-parametric Kruskal-Wallis test supplemented with Dunn-Bonferroni correction and Spearman rank-order correlation test were used to compare basic coagulation profiles and platelet parameters among the groups. The test result was expressed in median and interquartile range and presented in texts and tables. P-value < 0.05 was considered to be statistically significant.

RESULTS

Prothrombin time (PT) and international normalization ratio (INR) were significantly reduced in T2DM as compared to T1DM and healthy controls (p <0.05). Platelet distribution width (PDW) and mean platelet volume (MPV) were significantly increased in both T1DM and T2DM as compared to healthy controls (p <0.05). Moreover, PT and INR were negatively correlated with fasting blood glucose (FBG) among T1DM and PT, INR and activated partial thromboplastin time (APTT) were negatively correlated with FBG among T2DM.

CONCLUSION

Basic coagulation profiles and platelet parameters were significantly different between diabetes and controls where PT and INR in T2DM were significantly reduced as compared to T1DM and controls. However, PDW and MPV were significantly elevated in both T1DM and T2DM as compared to controls. Moreover, FBG was significantly negatively correlated with PT and INR among T1DM and FBG was significantly negatively correlated with PT, INR, and APTT among T2DM. Therefore, T2DM may be related to increased risk of thrombosis indicated by reduced PT and INR and high PDW and MPV than T1DM and controls. Basic coagulation profiles and platelet parameters should be regularly tested for early diagnosis and proper management of diabetes-related thrombosis.

Platelet Indices and Its Association with Microvascular Complications Among Type 2 Diabetes Mellitus Patients in Northeast Ethiopia: A Cross-Sectional Study

PURPOSE

Platelet indices have been shown to be associated with complications of diabetes mellitus (DM). However, the clinical relevance of platelet indices for assessing the risk of being microvascular complications among patients with DM is largely overlooked. Hence this study aimed to determine the association of platelet indices with microvascular complications among type 2 DM patients.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted among 352 type 2 DM patients from April 1 to May 30/2019 at Debre Berhan Referral Hospital. Data were collected by interview, physical measurements, document review, and laboratory tests. Then the data were entered into Epi-data manager-4.4.1.0 and exported into SPSS-25 for analysis. Platelet indices were compared between participants with and without microvascular complications using an independent t-test. A logistic regression model was used to assess the association between microvascular complications and platelet indices. All inferences were considered statistically significant at P<0.05.

RESULTS

One hundred seventeen (33.2%) of participants were suffering from at least one microvascular complications. The mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) were significantly increased in DM patients with complications as compared to without complications (13.57±2.17fl vs. 11.76±1.93fl), (16.57±2.49fl vs. 14.97±2.41fl) and (28.09±7.58% vs. 24.19±6.46%), respectively (all are P˂0.001). In multivariate logistic regression analysis, MPV (AOR=1.68, 95% CI: 1.37-2.05), PDW (AOR=1.37, 95% CI: 1.15-1.63), P-LCR (AOR=1.07, 95% CI: 1.01-1.14), age (AOR=1.07, 95% CI: 1.01-1.12), and duration of DM (AOR=1.31, 95% CI: 1.18-1.46) were significantly associated with the presence of microvascular complications.

CONCLUSION

MPV, PDW, and P-LCR were significantly higher among type 2 DM patients with microvascular complications. This indicates that platelet indices can be used as prognostic markers of vascular complications and can be used as simple and cost-effective parameters to predict microvascular complications particularly in patients with old age and long duration of DM.

Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men

AIM

Hemogram indices were proposed as novel inflammatory markers in chronic conditions and inflammation has substantial role in the pathogenesis of type 2 diabetes mellitus (T2DM). We aimed to observe hemogram parameters of type 2 diabetic male subjects with various age groups in well and poorly controlled subsets.

METHODS

Data of type 2 diabetic men enrolled to the study were recorded from patient files of the institution. Study population were grouped into three according to the age. Group A was consisted of patients younger than 55 years, Group B was consisted of patients aged between 55 and 64 years, and Group C was consisted of patients aged 65 years or older. Data of the study groups were compared.

RESULTS

Study population was consisted of 130 subjects; 44 in Group A and 43 in each of Groups B and C. Median red cell distribution width (RDW) (p = .04), mean RDW to platelet ratio (RPR) (p = .006), median mean platelet volume to platelet ratio (MPR) (p = .02) levels of the study groups were statistically different. HbA1c level was significantly and positively correlated with RDW (r = 0.45, p < .001), neutrophil to lymphocyte ratio (NLR) (r = 0.47, p < .001), mean platelet volume to lymphocyte ratio (MLR) (r = 0.35, p < .001), MPR (r = 0.26, p = .003), and RPR (r = 0.37, p < .001) levels.

CONCLUSION

Elevated RDW, NLR, MLR, MPR, and RPR levels in diabetic men should trigger the measurement of HbA1c since each were strongly correlated with HbA1c level. Moreover, elevated RDW, NLR, MLR, and RPR could be marker of worse diabetic control in men with T2DM.

Diabetes control could through platelet-to-lymphocyte ratio in hemograms

OBJECTIVE

Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers.

METHODS

Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed.

RESULTS

Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria.

CONCLUSION

As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.

Hemostatic state augmented with platelet indices among Sudanese diabetic septic foot

Background

Diabetes mellitus is a very rampant metabolic disorder, particularly type II. It has many complications such as the septic foot. Diabetic septic foot (DSF) patients are at high risk for coagulation abnormalities as well as surgical hazards. Owing to the potential sequelae of coagulation and vascular abnormalities, this work aimed at studying the hemostatic state and platelet indices in diabetes type II patients with septic foot.

Methods

A case-control study was conducted during the period from July to September 2017 at Dr. Awaad medical center, Red Sea State, Sudan. 57 diabetic patients with septic foot, aged between 17 and 78 years along with 57 non-diabetic subjects as control were enrolled. Sociodemographic data were collected using a structured questionnaire. Venipuncture blood was taken with necessary safety measures. Diabetes profile, coagulation studies as well as platelet indices were estimated. Data was analyzed using SPSS version 24.0 for windows. Ethical approval was considered and written consent from each participant was obtained.

Results

The mean age of diabetic patients with septic foot and healthy controls were 48.49 ± 15.8 and 32.77 ± 14.0, respectively. The duration of the diabetes onset was 10.43 ± 9.5 years. Plasma prothrombin time (PT) value (12.61 ± 2.6 vs 13.67 ± 1.5, P < 0.009) was found to be significantly shorter in DSF compared to control. Plasma activated partial thromboplastin time (APTT) value was significant in diabetic septic foot (32.64 ± 5.2 vs 28.49 ± 4.13, P < 0.000), and thrombin time (TT) did not changed in DSF. Mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) values were significantly decreased in DSF compared to control (P < 0.013, 0.034, and 0.020, respectively). PDW values were positively correlated with PT, APTT, and D-Dimer (DD) (r = 0.28/p < 0.003, r = 0.29/p < 0.029, and r = 0.32/p < 0.016, respectively). FVIII activity (121.86 ± 174.4 vs 98.66 ± 31.83, P < 0.951) was insignificant with DSF, as the DD was also insignificant (P < 0.081).

Conclusion

Diabetes mellitus is associated with prothrombotic tendency. Hypercoagulable state in DSF is indicated by shortened PT finding. PDW is a manifesting evidence that proves the presence of more reactive and aggregable platelets in DSF patients.

Association between mean platelet volume and severity of rheumatoid arthritis

Introduction

In recent years, it is suggested that platelet histogram indices, such as mean platelet volume (MPV) may be related to the activity of rheumatoid arthritis (RA). The aim of this study was to assess relationship between MPV and activity of rheumatoid arthritis.

Methods

Sixty consecutive patients fulfilling the American College of Rheumatology (ACR) criteria for RA were recruited from the rheumatology outpatient clinics in Semnan, Iran. Current disease activity score (DAS-28 score) was assessed at baseline, 2 months and 4 months after the admission time and beginning of the treatment schedule. Complete blood count (including MPV), C-reactive protein (CRP) and ESR were measured in each visit. MPV was analyzed by the Cell Dyne 3500 automated blood cell counter.

Results

There was a significant reduction in DAS-28 score within 4 months of total assessment (from 4.47 ± 2.24 versus 3.18 ± 1.55) (p < 0.001). There was no significant difference in MPV levels at the three study time points. No significant correlations were observed between the DAS-28 score and mean MPV levels at the same time points. The rate of positive CRP was decreased within the same period (p = 0.002); however, the trend of the changes in other laboratory parameters including MPV, platelet count and ESR values was not significant. The measurement of MPV value did not correlate with disease activity in RA patients within 4 months of treatment scheduling.

Conclusion

Although therapeutic regimens, which improve RA manifestations, can reduce RA activity, they had no effect on MPV during this time period. It seems MPV may not be able to predict disease activity in RA patients.

A Study of Platelet Indices in Type 2 Diabetes Mellitus Patients

Altered platelets have been reported in patients with diabetes mellitus and has been considered as a 'prothrombotic state' with enhanced platelet reactivity. They have been associated with increased risk of vascular complications in these patients. Platelet indices correlate with functional status of platelets and is an emerging risk factor of vascular complications in diabetes. The study was undertaken to know the efficacy of platelet analysis in assessing the prognosis of diabetes mellitus. A prospective hospital based study of platelet parameters MPV, PDW and P-LCR was carried out on 280 cases diagnosed with Type 2 diabetes Mellitus and 280 controls with normal blood glucose levels. The blood glucose levels and HbA1c level were also measured. Statistical evaluation was performed by using Student's unpaired t test and Pearson correlation test. The average age of presentation with type 2 diabetes mellitus was 53 ± 5.7 years. The mean duration of diabetes was 4.7 ± 2.5 years. MPV, PDW and P-LCR were significantly higher in diabetics compared to non diabetics (11.3 ± 1.0 vs. 9.0 ± 0.6, 14.2 ± 2.5 vs. 10.7 ± 0.7 fl, 35.0 ± 8.1 vs. 23.0 ± 2.4%). Among the diabetics, MPV, PDW and P-LCR were higher in those with complications as compared to those without complications, which was not statistically significant. The higher values of MPV, PDW and P-LCR indicates that they serve as better risk indicator of initial vascular complications in diabetes mellitus patients and can be used as a simple and cost effective tool to assess vascular events.

Serum TNF-α concentrations in type 2 diabetes mellitus patients and diabetic nephropathy patients: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to investigate whether the concentrations of serum tumor necrosis factor-α (TNF-α), a pro-inflammatory cytokine, increased in type 2 diabetes mellitus (T2DM) and type 2 diabetic nephropathy (T2DN) patients.

METHODS

The four databases (PubMed, CNKI, WanFang and Chinese-Cqvip) were searched from Jan 1, 1999 to October 1, 2016 for all clinical case-control studies about the serum TNF-α concentrations in T2DM and T2DN patients. All relevant data were extracted from published reports. The meta-analysis was performed to compare the changes of serum TNF-α concentrations of T2DN and T2DM patients in Eastern and Western with healthy controls. We further evaluated concentrations of serum TNF-α in T2DN patients with mincroalbuminuria or macroalbuminuria. Random-effects models were adopted to assess the pooling data among various variations.

RESULTS

In total of 6 studies (744 patients and 277 healthy controls) were included in this study. Compared with healthy controls (both p<0.01), the groups of different albuminuria levels and ethnicities both showed that the serum TNF-α levels were significantly elevated in T2DN patients as well as in eastern T2DN patients (p=0.001), but not significant changed in western T2DN patients (p=0.081). The results were stable through sensitivity analysis and no significant publications bias existed in this meta-analysis.

CONCLUSIONS

Serum TNF-α concentrations are obviously increased in T2DN and T2DM patients, but higher in T2DN patients, suggesting an elevated inflammatory burden in T2DN patients.

Association between mean platelet volume and hypertension incidence

Mean platelet volume (MPV) is increased in various cardiovascular diseases. We sought to determine the prognostic value of MPV for hypertension. We performed a retrospective cohort study. Baseline characteristics were measured in 9168 individuals without hypertension, and the follow-up period was 9 years. Hypertension was confirmed in 2881 participants during the follow-up period. When the participants were grouped according to MPV quartiles, the hazard ratio of future hypertension gradually increased across the MPV quartiles. The hazard ratios of hypertension for the II, III and IV (high) vs. I (low) quartiles of MPV were 1.13 (95% confidence interval (CI) 1.01-1.25, P=0.027), 1.25 (95% CI 1.12-1.39, P<0.001) and 1.40 (95% CI 1.26-1.55, P<0.001), respectively. In multivariate Cox regression analysis, MPV predicted hypertension independently of age, sex, platelet count, waist circumference, drinking, systolic blood pressure and creatinine levels. The present study indicated that elevated MPV is associated with increased incidence of hypertension independent of other risk factors, which suggests that platelet activity may play a role in hypertension incidence.

The association of hematologic inflammatory markers with atherogenic index in type 2 diabetic retinopathy patients

BACKGROUND

Atherogenic dyslipidemia is particularly common in people with type 2 diabetes (DM2). Platelets from patients with DM2 have increased reactivity and baseline activation. The aim of the present study is to evaluate the relationship between atherogenic index and hematologic inflammatory markers and to evaluate the relationship between these parameters and associated variables in diabetic retinopathy (DR) patients.

METHODS

The medical records of all patients admitted to the eye clinic between January and December 2014 were evaluated systematically. Laboratory parameters of 278 outpatients with DM2 diagnosed after the age of 30 years and 107 healthy subjects were analyzed.

RESULTS

The DM2 + DR group consisted of 120 patients (47 males and 73 females; mean age 59.8±9.2 years). The DM2 without DR group consisted of 158 patients (59 males and 99 females; mean age 57.3±12.2 years). Mean platelet volume, platelet distribution width (PDW), platelet-lymphocyte (P/L) ratio, triglycerides, and atherogenic index were higher in DM2 patients than in control patients, but there was no difference between the DM2 + DR and the DM2 without DR groups. Only P/L ratio was different in the DM2 + DR patients compared to the DM2 without DR patients. Hemoglobin A1c levels correlated very weakly with the mean platelet volume, PDW, P/L ratio, and the red cell distribution width. The atherogenic index was very weakly correlated with the P/L ratio, PDW, and red cell distribution width.

CONCLUSION

Dyslipidemia-induced inflammation contributes to pathological processes that lead to retinopathy in DR patients.

Elevated expression levels of serum insulin-like growth factor-1, tumor necrosis factor-α and vascular endothelial growth factor 165 might exacerbate type 2 diabetic nephropathy

AIMS/INTRODUCTION

The present study aimed to determine the associations between expressions of insulin-like growth factor-1 (IGF-1), tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor 165 (VEGF₁₆₅ ) in serum, and occurrence and development of type 2 diabetic nephropathy (DN).

MATERIALS AND METHODS

A total of 108 patients diagnosed as DN were randomly selected, including 50 patients in the microalbuminuria group, 44 patients in the macroalbuminuria group and 14 patients in the renal insufficiency group. Meanwhile, 97 healthy people were collected as a normal control group. Urinary albumin (UALB) and urine creatinine (Cr) of all participants were measured for 24 h, with their ratio (UALB/Cr) being calculated. Enzyme-linked immunosorbent assay was used to detect the serum concentrations of IGF-1, TNF-α and VEGF₁₆₅ .

RESULTS

The expressions of serum IGF-1, TNF-α and VEGF₁₆₅ in the type 2 DN patients were significantly higher than those in the control group (all P < 0.05). The expressions of serum IGF-1, TNF-α and VEGF₁₆₅ in the type 2 DN patients were positively correlated with UALB/Cr (all P < 0.05). As type 2 DN worsened, the expressions of serum IGF-1, TNF-α and VEGF₁₆₅ increased, and type 2 DN severity had positive correlations with serum IGF-1, TNF-α and VEGF₁₆₅ concentrations (all P < 0.05). There was a positive association between IGF-1 and TNF-α, IGF-1 and VEGF₁₆₅ , and TNF-α and VEGF₁₆₅ (all P < 0.05). Logistic regression analysis showed that IGF-1 and VEGF₁₆₅ were associated with the progression of DN (both P < 0.05).

CONCLUSIONS

Elevated expression levels of serum IGF-1, TNF-α and VEGF₁₆₅ might exacerbate type 2 DN.

Relationship between Altered Platelet Morphological Parameters and Retinopathy in Patients with Type 2 Diabetes Mellitus

Purpose. To investigate whether platelet morphology or function is altered in patients with diabetic retinopathy (DR). Methods. This prospective study enrolled 85 healthy controls (HCs) (group 1) and 262 patients with Type 2 diabetes mellitus (T2DM). Patients were subclassified into three groups according to ocular findings: no DR (group 2; n = 88); nonproliferative DR (group 3; n = 88), and proliferative DR (group 4; n = 86). Mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (PLCR), plateletcrit (PCT) values, and platelet count were measured in the studied groups. Results. MPV, PDW, and PLCR levels were significantly altered in groups 2-4 compared with HCs (p < 0.05, p < 0.05, p < 0.05). Compared with group 2, both DR groups had higher MPV and PDW levels, with a significant difference between groups 2 and 4 for both MPV (p = 0.036) and PDW (p = 0.006). PLCR correlated with retinopathy stage, but no significant difference was found between the DR groups. Platelet count and PCT values were not significantly different between the groups (p > 0.05). Conclusion. Our findings suggest an association between mean platelet indices (MPI) (i.e., MPV, PDW, and PLCR) and DR stage. Therefore, MPI could be a beneficial prognostic marker of DR in patients with T2DM.

Association of hematological indicies with diabetes, impaired glucose regulation and microvascular complications of diabetes

In recent years, there has been renewed interest in hematological parameters as predictors of endothelial dysfunction and inflammation. The aim of our study is to evaluate the relationship between HbA1c and hematological indices, and to evaluate the relationship between these parameters and microvascular complications of diabetes. Three hundred and seven diabetic patients (124 male, 183 female; mean age 50.8±8.5), and 187 controls (76 male, 111 female; mean age 51.1±10.1) were included in the study. In the diabetic group, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), white blood cell count (WBC), platelet count, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) were significantly higher than the control group (P<0.05). Diabetic patients were divided into two group according to their HbA1c levels (Group 1; HbA1c <7 (n=82) and group 2; HbA1c ≥7 (n=225)). Mean platelet volume, PCT and PDW levels were significantly increased in group 2. Mean platelet volume was significantly increased in diabetic patients with retinopathy compared to those without retinopathy (P=0.006). The neutrophil to lymphocyte ratio and PLR levels were significantly higher in patients with nephropathy (P=0.004, P=0.004 respectively). There was statistically significant difference of lymphocyte count between patients with and without neuropathy. In correlation analysis, positive correlation between HbA1c and PCT (rs=0.192, P<0.001), HbA1c and PDW (rs=0.305, P<0.001), HbA1c and MPV (rs=0.352, P<0.001) were determined. In binary logistic regression analysis; WBC, PDW and PLR levels were found to be independently associated with diagnosis of diabetes while WBC, MPV, PLR and NLR levels were found to be independently associated with impaired glucose regulation. This study demonstrates that altered hematological indices are closely associated with HbA1c levels in individuals with and without diabetes and some of these parameters are associated with diabetic microvascular complications. These associations may be explained by connection between these easy accessible and inexpensive hematological indices and inflammation, tendency to coagulation and thrombosis in patients with diabetes.

Diabetic Lactoferrin Deficient Mice Demonstrates Greater Susceptibility to Experimental Periodontal Disease

The objective of this study is to detrmine whether alloxan-induced diabetic Lactoferrin knockout (LFKO^-/-) mice are more susceptible to periodontal disease caused by Aggregatibacter actinomycetemcomitans compared to the diabetic wild-type (WT) mice. Diabetes was induced in mice by a single dose of alloxan (60 mg/kg) injected intravenously. Mice were categorized as diabetic when blood glucose levels >250 mg/dL were measured on the 7^th day after the injection. Periodontal disease was experimentally induced by A. actinomycetemcomitans infection in alloxan induced diabetic WT and LFKO^-/- mice. Fasting blood glucose levels and body weight were monitored throughout the study. At the end of the 12^th week of infection, mice were sacrificed and bone loss among the groups was estimated by measuring the distance between cemento-enamel junction (CEJ) to the alveolar bone crest (ABC) at 12 sites on the molars. A. actinomycetemcomitans infected mice groups developed more alveolar bone loss than sham-infected animals. Diabetic LFKO^-/- infected mice exhibited significant bone loss (P<0.01) and a higher mean fasting blood glucose level (P<0.05) when compared to diabetic WT infected mice. No statistically significant difference in fasting blood glucose level was found between the infected and sham-infected groups. Peripheral blood analysis at the end of the 12^th week revealed a significant reduction in the platelet counts in LFKO^-/- mice when compared to WT mice. Furthermore, diabetic LFKO^-/- presented with lower counts than non-diabetic LFKO^-/- mice (P<0.01). In conclusion, diabetic lactoferrin deficient mice are at a higher risk of developing periodontal infection induced by A. actinomycetemcomitans when compared to diabetic WTI mice.

Red cell distribution width in type 2 diabetic patients

OBJECTIVE

To study the indices of some elements of the complete blood count, in type 2 diabetic patients, in comparison with nondiabetic healthy controls; and to find out the effects of glycemic control and different medications on these indices. To the best of our knowledge, this study is novel in our environment and will serve as a foundation for other researchers in this field.

METHODS

This retrospective study included 260 type 2 diabetic patients on treatment and 44 healthy control subjects. Sex, age, weight, height, blood pressure, complete blood count, fasting plasma glucose, hemoglobin A1c (HbA1c), and lipid profile data, were available for all of the study population. For diabetic patients, data on duration of diabetes and all medications were also available.

RESULTS

Red cell distribution width (RDW) was significantly higher in diabetic patients than in control subjects (P=0.008). It was also higher in patients with uncontrolled glycemia (HbA1c >7%) than those with good control (HbA1c ≤7%; P=0.035). Mean platelet volume (MPV) was comparable in both diabetic patients and healthy controls (P=0.238). RDW and MPV did not significantly correlate with fasting plasma glucose, HbA1c, or duration of diabetes. Both aspirin and clopidogrel did not show a significant effect on MPV. Both insulin and oral hypoglycemic agents did not show a significant effect on RDW, mean corpuscular volume, MPV, platelet count, or white blood cell count. Diabetic patients treated with indapamide or the combined thiazides and angiotensin receptor blockers showed no significant difference in RDW when compared with the control subjects.

CONCLUSION

RDW, which is recently considered as an inflammatory marker with a significant predictive value of mortality in diseased and healthy populations, is significantly higher in diabetic patients than healthy subjects and is particularly higher in uncontrolled glycemia. None of the studied hypoglycemic agents showed a significant effect on RDW. Diabetic hypertensive patients receiving antihypertensive therapy in the form of indapamide or the combined therapy of thiazides and angiotensin receptor blockers have RDW values comparable to those of the healthy population.