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

Erythrocyte-related indicators as biomarkers in diabetes: Improvement of erythrocyte function by fruit extracts from different cultivars of the cornelian cherry (Cornus mas L. and Cornus mas × Сornus officinalis hybrids)

Complementary pharmacological therapy using plant-based raw materials is necessary for normalizing the overall condition and reducing the risk of diabetic complications in type 1 diabetes. The search for natural remedies that prevent dysfunctions, particularly in blood cells, which are primarily exposed to prolonged hyperglycemia impacts, is especially important. This study aimed at evaluating diagnostically significant erythrocyte parameters in animals with streptozotocin-induced diabetes after administration of fruit extracts from Cornus mas cultivars `Uholok´ and `Koralovyi´ and Cornus mas × Cornus officinalis hybrids, for 14 days at a dose of 20 mg/kg body weight per day. The extracts were found to normalise erythrocyte parameters, including reticulocyte content in the blood, daily production of reticulocytes, erythrocyte count, haemoglobin concentrations, and mean cell haemoglobin. Oral administration of the studied extracts led to a rightward shift in the oxyhaemoglobin dissociation curves and an increase in P50 values, indicating a reduction in haemoglobin affinity for oxygen to physiological levels, and caused a decrease in methaemoglobin content. Metabolites of anaerobic glycolysis, antioxidant enzyme activity, oxidative and nitrative stress biomarkers in the erythrocytes of diabetic rats decreased to control levels. The reduction in oxidative damage to erythrocytes, attributed to the strong antioxidant properties of the extracts, contributed to enhanced resistance to haemolysis and an increase in sialic acid-containing glycans that provide erythrocytes with a negative charge, reducing their aggregability. Cornelian cherry fruit extracts are promising sources of bioactive compounds for the development of potential antidiabetic medicines, while erythrocytes serve as indicators of the effectiveness of such pharmacotherapy.

First Trimester Hematological Indices in Gestational Diabetes Mellitus: A Meta-Analysis

Context

The association between blood parameters and gestational diabetes (GDM) is of renewed interest. Some blood cell parameters are assumed to be associated with GDM.

Objective

This meta-analysis was performed to assess the association of hematological indices in the first trimester of pregnancy and later development of GDM.

Methods

A comprehensive database search, including PubMed, Web of Science, Epistemonikos, Scopus, Scientific Information Database, and Magiran, was conducted to identify potential peer-reviewed publications. The PECO framework was applied to evaluate the eligibility of all included studies. Standardized mean differences (95% CI), were calculated. Additionally, pooled odds ratios, summary estimates of sensitivity and specificity, positive and negative likelihood ratios, and diagnostic odds ratios (DOR) were determined.

Results

The meta-analysis encompassed 33 studies involving a total of 247 107 pregnant women. Compared to control groups, GDM groups exhibited statistically significantly higher hemoglobin levels (standard mean difference: 0.50, 95% CI: 0.39-0.62), red blood cell (RBC) (0.23, 0.15-0.32), and hematocrit (0.44, 0.34-0.55). The pooled adjusted estimate (aOR:1.02, 1.006-1.03) indicated that the hemoglobin levels were significantly associated with an increased risk of GDM. GDM groups had significantly higher platelet count (0.280, 0.16-0.39) and white blood cells (WBC) counts, as well as (0.482, 0.377-0.58), lymphocytes (0.12, 0.025-0.22), neutrophils (0.541:0.404-0.679), and neutrophil-lymphocyte ratio (0.31, 0.20-0.43). In distinguishing women with GDM from the control group, the DOR was found to be 3.21 for the hemoglobin and 2.94 for the mean platelet volume.

Conclusion

Higher levels of RBC, platelet, and WBC counts during the first trimester of pregnancy were observed in women who subsequently developed GDM compared to control groups.

Changes in selected hematological parameters in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis

Background

Diabetes mellitus is a chronic metabolic disorder that causes hyperglycemia and various life-threatening health problems. Although hematological parameters play a significant role in the progression and pathogenesis of diabetes, many studies have explored contradictory findings. Therefore, this evidence-based study aimed to determine the pooled mean difference of white blood cell and red blood cell parameters in diabetic patients in order to investigate hematological dysfunctions in type 1 and type 2 diabetes mellitus.

Methods

Articles were extensively searched in bibliographic databases (PubMed, Cochrane library, Scopus, Web of Science, PsycINFO, Embase, online archives and university repositories) using appropriate entry terms. For studies meeting the eligibility criteria, the first author's name, year of publication, study design and area, type of diabetes mellitus, sample size, and mean and standard deviation of hematological parameters were extracted using Microsoft Excel and exported to Stata 11 for meta-analysis. The pooled standardized mean difference (SMD) was determined using the random effects model, and heterogeneity was quantified using Higgins' I2 statistics. Egger's test and funnel plot were performed to measure bias. Furthermore, a sensitivity analysis was performed to determine the small study effect.

Results

Initially 39, 222 articles were identified. After screening of the entire methodology, 22 articles with 14,041 study participants (6,146 T2DM, 416 T1DM patients and 7,479 healthy controls) were included in this study. The pooled SMD in TLC (109/L) was 0.66 and -0.21, in T2DM and T1DM, respectively. Differences in absolute differential WBC counts for neutrophils, eosinophils, basophils, lymphocytes and monocytes in T2DM were 0.84, -1.59, 3.20, 0.36 and 0.26, respectively. The differences in relative differential counts (%) in T2DM were as follows: neutrophils: 1.31, eosinophils: -0.99, basophils: 0.34, lymphocytes: -0.19 and monocyte: -0.64. The SMD of differential counts of WBC (109/L) parameters; neutrophils, lymphocytes, monocytes and basophils in T1DM were -0.10, -0.69, 0.19, and -0.32, respectively. The pooled SMD in RBC parameters in T2DM were as follows: RBC: -0.57 (106/μL), Hb: -0.73 g/dL and HCT: -1.22%, Where as in T1DM RBC, Hb and HCT were -1.23 (106/μL), -0.80 g/dL and -0.29%, respectively.

Conclusion

Patients with T2DM had significantly increased TLC counts, absolute neutrophil, basophil, lymphocyte, monocyte counts and relative counts of neutrophils and basophils in comparison to controls. On the contrary, the absolute eosinophil count and relative lymphocyte, eosinophil and monocyte counts were decreased. In T1DM, WBC parameters were significantly decreased except monocytes. RBC parameters were found to be significantly decreased in T2DM patients. In T1DM, Hb and HCT were significantly decreased. However, there is no significant difference in RBC as compared with non-diabetic controls. The findings indicated a significant alteration of WBC and RBC parameters in both diabetic patients suggesting the considerable metabolic effect of diabetes on hematologic parameters.

Systematic review registration

https://www.crd.york.ac.uk/prospero/export_details_pdf.php, identifier [CRD42023413486].

Role of liver parameters in diabetes mellitus - a narrative review

Diabetes mellitus is characterized by hyperglycemia and abnormalities in insulin secretion and function. This review article focuses on various liver parameters, including albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), alpha fetoprotein (AFP), alpha 1 antitrypsin (AAT), ammonia, bilirubin, bile acid, gamma-glutamyl transferase (GGT), immunoglobulin, lactate dehydrogenase (LDH), and total protein. These parameters play significant roles in the development of different types of diabetes such as type 1 diabetes (T1DM), type 2 diabetes (T2DM) and gestational diabetes (GDM). The article highlights that low albumin levels may indicate inflammation, while increased ALT and AST levels are associated with liver inflammation or injury, particularly in non-alcoholic fatty liver disease (NAFLD). Elevated ALP levels can be influenced by liver inflammation, biliary dysfunction, or bone metabolism changes. High bilirubin levels are independently linked to albuminuria in T1DM and an increased risk of T2DM. Elevated GGT levels are proposed as markers of oxidative stress and liver dysfunction in T2DM. In GDM, decreased serum AFP levels may indicate impaired embryo growth. Decreased AFP levels in T2DM can hinder the detection of hepatocellular carcinoma. Hyperammonemia can cause encephalopathy in diabetic ketoacidosis, and children with T1DM and attention deficit hyperactivity disorder often exhibit higher ammonia levels. T2DM disrupts the regulation of nitrogen-related metabolites, leading to increased blood ammonia levels. Bile acids affect glucose regulation by activating receptors on cell surfaces and nuclei, and changes in bile acid metabolism are observed in T2DM. Increased LDH activity reflects metabolic disturbances in glucose utilization and lactate production, contributing to diabetic complications. Poor glycemic management may be associated with elevated levels of IgA and IgG serum antibodies, and increased immunoglobulin levels are also associated with T2DM.