Role and Significance of Hematological parameters in Diabetes Mellitus
Keywords:
Diabetes Mellitus, HbA1c, CBC, red cell parameters
Abstract
Background: Diabetes mellitus is a global metabolic disorder characterized by persistent hyperglycemia and increased risk of microvascular and macrovascular complications. Consistent elevation of HbA1c can be associated with functional and structural changes in hemoglobin molecule, cytoplasmic viscosity and osmotic disturbances within red cell. These changes may be reflected in the red cell analytical parameters. Methods: 120 subjects were studied. 41 were non diabetic healthy subjects (Group1). 79 were known diabetic patients, divided into two groups: HbA1c <7(39 subjects) Group 2 and HbA1c >7(40 subjects) Group 3. Sample for glucose estimation and CBC were collected in vacutainers containing sodium Fluoride and K 2EDTA respectively. Glucose, HbA1c and CBC estimation was carried out by auto analyzers. Result: Mean RBC count of diabetics with HbA1c<7 was less when compared to non-diabetic individuals. Significant decrease was noted in the mean RBC count, Hb, HCT and MCV of diabetics with HbA1c>7 when compared to non diabetic individuals. There was significant decrease in mean Hb, HCT, MCV, MCH of diabetics with HbA1c >7 when compared to diabetics with HbA1c <7. Conclusion: The findings in the present study suggest that diabetic patients with poor control are more prone to develop anemia. This indicates a need for routine CBP examination for early detection and management of anemia in diabetic patients at the primary care setting to reduce associated morbidity due to lowered immunity associated with anemia and complications such as diabetic ketoacidosis.References
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2. Zimmet P, Alberti KG, Shaw J. Global and social implication of the diabetes epidemics. Nature 2001;414:782-7.
3. Groop L, OrhoMelander M. The dysmetabolic syndrome .J Intern Med. 2001;250:105-20.
4. Rodriguez-Manas L, Arribas S, Giron C, Villamor J, Sanchez-Ferrer C, Marin J. Interference of glycosylated human hemoglobin with endothelium- dependent responses. Circulation 1993; 88(5):2111-2116.
5. Watala C, Witas H, Olszowska L, Piasecki W. The association between erythrocyte internal viscosity, protein non-enzymatic glycosylation and erythrocyte membrane dynamic properties in juvenile diabetes mellitus. International journal of experimental pathology 1992;73(5):655–663.
6. Watala C, Golanski J, Witas H, et al. The effects of in vivo and in vitro non-enzymatic glycosylation and glycoxidation on physico-chemical properties of haemoglobin in control and diabetic patients.The international journal of biochemistry & cell biology. 1996 Dec;28(12):1393-1403.
7. Evans TC, Jehle D. The red blood cell distribution width. The Journal of emergency medicine 1991;9Suppl 1:71–74
8. Magri C, Fava S. Red blood cell distribution width and diabetes-associated complications. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2014;8(1):13-17.
9. Colwell JA, Nesto RW. The platelet in diabetes. Focus on prevention of ischemic events. Diabetes care 2003;2:2181-8.
10. Yazbek N, Bapat A, Kleiman N. Platelet abnormalities in diabetes mellitus. Coron Artery Dis 2003;114:365-71.
11. Papanas N, Symeonidis G, Maltezos E, Mavridis G, Karavageli E, Vosnakidis T et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets. 2004 Dec;15(8):475-8.
12. Tschoepe D, Roesen P, Kaufmann L, Schauseil S, Kehrel B, Ostermann H et al. Evidence of abnormal platelet expression in diabetes mellitus. Eur J Clin Invest.1990;20(2):166-70.;Ebil N, Krugluger W, Strait G, Hopemier P, Scherntham G. Improved metabolic control decreases platelet activation marker in patient with type 2 diabetes mellitus. Eur J clin Invest. 2004;34(3):205-9.;Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B et al. Mean platelet volume asa predictor of cardiovascular risk: a systematic review and meta- analysis. J ThrombHaemost. 2010;8:148-56.
13. O'Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patient. Stroke. 1995;26:995-9.
14. White B. Hormonal regulation of energy metabolism. In: Koeppen B, Stanton B, editors. In: Berne and Levy Physiology 6th edition. Mosby Elsevier; 2010:676-689.
15. Virtue MA, Furne JK, Nuttall FQ, Levitt MD. Relationship between GHb concentration and erythrocyte survival determined from breath carbonmonoxide concentration. J Diabetes Care. 2004;27:931-5.
16. Schmid-Schonbein H, Volger E. Red-cell aggregation and red-cell deformability in diabetes. J Diabetes. 1976;25:897-902.
17. McMillan DE, Utterback NG, La PJ. Reduced erythrocyte deformability in diabetes.J Diabetes. 1978;27:895-901.
18. Agrawal R, Thomas S, João N, Christopher R, Rhythm B, Adnan T, et al. Assessment of red blood cell deformability in type 2 diabetes mellitus and diabetic retinopathy by dual optical tweezers stretching technique. Sci Reports 2016;6:15873.
19. Al Salhen, Khaled S, Mahmoud, Ameerah Y. Hematological profile of patients with type 2 Diabetic mellitus in El-Beida, Libya. Ibnosina J Med Biomed Sci. 2017;9(3):76-80.
20. M. C. Carvalho, E. C. E. Baracat, and V. C. Sgarbieri, “Anemia ferropriva e anemia de doenc¸acrˆonica: dist´urbios do metabolismo de ferro,” RevistaSeguranc¸aAlimentar e Nutricional, vol. 13, no. 2, pp. 54–63, 2006.
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22. B. Martínez-Pérez, I. De La Torre-Díez, and M. López-Coronado, “Mobile health applications for the most prevalent conditions by the World Health Organization: review and analysis,” Journal of Medical Internet Research, vol. 15, no. 6, article e120, 2013. View at Publisher • View at Google Scholar • View at Scopus
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24.Al-Khoury S, Afzali B, Shah N, Covic A, Thomas S,Goldsmith DJ. Anaemia in diabetic patients with chronic kidney disease: prevalence and predictors. Diabetologia 2006;49:1183-9.
25. Mohammed A, Adelaiye AB, Bakari AG, Mabrouk MA. Antidiabetic and some hematological effects of ethyl acetate and n-butanol fractions of Ganodermalucidum aqueous extract in alloxan-induced diabetic wistar rats. Intern J Medicine Sci. 2009;1(12):530-5.
26. Edet EE, Akpanabiatu MI, Uboh FE, Edet TE, Eno AE, Itam EH, et al. Gongronemalatifolium crude leaf extract reverses alterations in hematological
indices and weight loss in diabetic rats. J PharmacolToxicol. 2011;6:174-81.
27. Waggiallah H, Alzohairy M. The effect of oxidative stress on human red cells glutathione peroxidase, glutathione reductase level, and prevalence of anemia among diabetics. North Am J Med Sci. 2011;3(7):344-7.
28. Kim JH, Bae HY and Kim SY. Response: clinical marker of platelet hyperreactivity in diabetes mellitus (diabetes metab j 2013;37:423-8). Diabetes Metab J 2014; 38: 160-161.
29. Suslova TE, Sitozhevskii AV, Ogurkova ON, Kravchenko ES, Kologrivova IV, AnfinogenovaYandKarpov RS. Platelet hemostasis in patients with metabolic syndrome and type 2 diabetes mellitus: cGMP-and No-dependent mecha¬nisms in the insulin-mediated platelet aggre¬gation. Front Physiol 2014; 5: 501.
30. El Haouari M and Rosado JA. Platelet signalling abnormalities in patients with type 2 diabetes mellitus: a review. Blood Cells Mol Dis 2008; 41: 119-123.
31. Ergelen M and Uyarel H. Plateletcrit: a novel prognostic marker for acute coronary syn-drome. Int J Cardiol 2014; 177: 161.
32. Jabeen F, Fawwad A, Rizvi HA and Alvi F. Role of platelet indices, glycemic control and hs-CRP in pathogenesis of vascular complications in type-2 diabetic patients. Pak J Med Sci 2013; 29: 152-156.
33. Erdogan S, Ozdemir O, Dogan HO, Sezer S, Atalay CR, Meric F, Yilmaz FM and Koca Y. Liver enzymes, mean platelet volume, and red cell distribution width in gestational diabetes. Turk J Med Sci 2014; 44: 121-125.
34. Citirik M, Beyazyildiz E, Simsek M, Beyazyildiz O and Haznedaroglu IC. MPV may reflect sub¬cinical platelet activation in diabetic patients with and without diabetic retinopathy. Eye (Lond) 2014; 29: 376-9.
35. Gasparyan AY, Ayvazyan L, Mikhailidis DP and Kitas GD. Mean platelet volume: a link be¬tween thrombosis and inflammation? Curr Pharm Des 2011; 17: 47-58.
36. Zuberi BF, Akhtar N and Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-dia¬betic subjects. Singapore Med J 2008; 49: 114-116.
37. Hekimsoy Z, Payzin B, Ornek T and Kandogan G. Mean platelet volume in Type 2 diabetic pa¬tients. J Diabetes Complications 2004; 18: 173-176.
38. Bavbek N, Kargili A, Kaftan O, Karakurt F, Kosar A and Akcay A. Elevated concentrations of soluble adhesion molecules and large plate¬lets in diabetic patients: are they markers of vascular disease and diabetic nephropathy? ClinApplThrombHemost 2007; 13: 391-397.
39. Tavil Y, Sen N, Yazici H, Turfan M, Hizal F, Cengel A and Abaci A. Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients. Platelets 2010; 21: 368-372.
40. Xiao W, Huang Y, Dong J, Zhang X and Hu J. Relationship between platelet volume indices with macrovascular and peripheral neuropathy complications in type 2 diabetic patients. J Diabetes 2014; 6: 298-303.
41. Lippi G, Salvagno GL, Nouvenne A, Meschi T, Borghi L and Targher G. The mean platelet vol¬ume is significantly associated with higher gly¬cated hemoglobin in a large population of un¬selected outpatients.Prim Care Diabetes 2015; 9: 226-30.
42. Bekler A, Ozkan MT, Tenekecioglu E, Gazi E, Yener AU, Temiz A, Altun B, Barutcu A, Erbag G and Binnetoglu E. Increased Platelet Dis-tribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome. Angiology 2014; 66: 638-43
43. Jindal S, Gupta S, Gupta R, Kakkar A, Singh HV, Gupta K and Singh S. Platelet indices in diabe¬tes mellitus: indicators of diabetic microvascu¬lar complications. Hematology 2011; 16: 86-89.
44. Erdogan S, Ozdemir O, Dogan HO, Sezer S, Atalay CR, Meric F, Yilmaz FM and Koca Y. Liver enzymes, mean platelet volume, and red cell distribution width in gestational diabetes. Turk J Med Sci 2014; 44: 121-125.
2. Zimmet P, Alberti KG, Shaw J. Global and social implication of the diabetes epidemics. Nature 2001;414:782-7.
3. Groop L, OrhoMelander M. The dysmetabolic syndrome .J Intern Med. 2001;250:105-20.
4. Rodriguez-Manas L, Arribas S, Giron C, Villamor J, Sanchez-Ferrer C, Marin J. Interference of glycosylated human hemoglobin with endothelium- dependent responses. Circulation 1993; 88(5):2111-2116.
5. Watala C, Witas H, Olszowska L, Piasecki W. The association between erythrocyte internal viscosity, protein non-enzymatic glycosylation and erythrocyte membrane dynamic properties in juvenile diabetes mellitus. International journal of experimental pathology 1992;73(5):655–663.
6. Watala C, Golanski J, Witas H, et al. The effects of in vivo and in vitro non-enzymatic glycosylation and glycoxidation on physico-chemical properties of haemoglobin in control and diabetic patients.The international journal of biochemistry & cell biology. 1996 Dec;28(12):1393-1403.
7. Evans TC, Jehle D. The red blood cell distribution width. The Journal of emergency medicine 1991;9Suppl 1:71–74
8. Magri C, Fava S. Red blood cell distribution width and diabetes-associated complications. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2014;8(1):13-17.
9. Colwell JA, Nesto RW. The platelet in diabetes. Focus on prevention of ischemic events. Diabetes care 2003;2:2181-8.
10. Yazbek N, Bapat A, Kleiman N. Platelet abnormalities in diabetes mellitus. Coron Artery Dis 2003;114:365-71.
11. Papanas N, Symeonidis G, Maltezos E, Mavridis G, Karavageli E, Vosnakidis T et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets. 2004 Dec;15(8):475-8.
12. Tschoepe D, Roesen P, Kaufmann L, Schauseil S, Kehrel B, Ostermann H et al. Evidence of abnormal platelet expression in diabetes mellitus. Eur J Clin Invest.1990;20(2):166-70.;Ebil N, Krugluger W, Strait G, Hopemier P, Scherntham G. Improved metabolic control decreases platelet activation marker in patient with type 2 diabetes mellitus. Eur J clin Invest. 2004;34(3):205-9.;Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B et al. Mean platelet volume asa predictor of cardiovascular risk: a systematic review and meta- analysis. J ThrombHaemost. 2010;8:148-56.
13. O'Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patient. Stroke. 1995;26:995-9.
14. White B. Hormonal regulation of energy metabolism. In: Koeppen B, Stanton B, editors. In: Berne and Levy Physiology 6th edition. Mosby Elsevier; 2010:676-689.
15. Virtue MA, Furne JK, Nuttall FQ, Levitt MD. Relationship between GHb concentration and erythrocyte survival determined from breath carbonmonoxide concentration. J Diabetes Care. 2004;27:931-5.
16. Schmid-Schonbein H, Volger E. Red-cell aggregation and red-cell deformability in diabetes. J Diabetes. 1976;25:897-902.
17. McMillan DE, Utterback NG, La PJ. Reduced erythrocyte deformability in diabetes.J Diabetes. 1978;27:895-901.
18. Agrawal R, Thomas S, João N, Christopher R, Rhythm B, Adnan T, et al. Assessment of red blood cell deformability in type 2 diabetes mellitus and diabetic retinopathy by dual optical tweezers stretching technique. Sci Reports 2016;6:15873.
19. Al Salhen, Khaled S, Mahmoud, Ameerah Y. Hematological profile of patients with type 2 Diabetic mellitus in El-Beida, Libya. Ibnosina J Med Biomed Sci. 2017;9(3):76-80.
20. M. C. Carvalho, E. C. E. Baracat, and V. C. Sgarbieri, “Anemia ferropriva e anemia de doenc¸acrˆonica: dist´urbios do metabolismo de ferro,” RevistaSeguranc¸aAlimentar e Nutricional, vol. 13, no. 2, pp. 54–63, 2006.
21. A. Angelousi and E. Larger, “Anaemia, a common but often unrecognized risk in diabetic patients: a review,” Diabetes & Metabolism, vol. 41, no. 1, pp. 18–27, 2015. View at Publisher • View at Google Scholar • View at Scopus
22. B. Martínez-Pérez, I. De La Torre-Díez, and M. López-Coronado, “Mobile health applications for the most prevalent conditions by the World Health Organization: review and analysis,” Journal of Medical Internet Research, vol. 15, no. 6, article e120, 2013. View at Publisher • View at Google Scholar • View at Scopus
23. S. Fava, J. Azzopardi, S. Ellard, and A. T. Hattersley, “ACE gene polymorphism as a prognostic indicator in patients with type 2 diabetes and established renal disease,” Diabetes Care, vol. 24, no. 12, pp. 2115–2120, 2001. View at Publisher • View at Google Scholar • View at Scopus
24.Al-Khoury S, Afzali B, Shah N, Covic A, Thomas S,Goldsmith DJ. Anaemia in diabetic patients with chronic kidney disease: prevalence and predictors. Diabetologia 2006;49:1183-9.
25. Mohammed A, Adelaiye AB, Bakari AG, Mabrouk MA. Antidiabetic and some hematological effects of ethyl acetate and n-butanol fractions of Ganodermalucidum aqueous extract in alloxan-induced diabetic wistar rats. Intern J Medicine Sci. 2009;1(12):530-5.
26. Edet EE, Akpanabiatu MI, Uboh FE, Edet TE, Eno AE, Itam EH, et al. Gongronemalatifolium crude leaf extract reverses alterations in hematological
indices and weight loss in diabetic rats. J PharmacolToxicol. 2011;6:174-81.
27. Waggiallah H, Alzohairy M. The effect of oxidative stress on human red cells glutathione peroxidase, glutathione reductase level, and prevalence of anemia among diabetics. North Am J Med Sci. 2011;3(7):344-7.
28. Kim JH, Bae HY and Kim SY. Response: clinical marker of platelet hyperreactivity in diabetes mellitus (diabetes metab j 2013;37:423-8). Diabetes Metab J 2014; 38: 160-161.
29. Suslova TE, Sitozhevskii AV, Ogurkova ON, Kravchenko ES, Kologrivova IV, AnfinogenovaYandKarpov RS. Platelet hemostasis in patients with metabolic syndrome and type 2 diabetes mellitus: cGMP-and No-dependent mecha¬nisms in the insulin-mediated platelet aggre¬gation. Front Physiol 2014; 5: 501.
30. El Haouari M and Rosado JA. Platelet signalling abnormalities in patients with type 2 diabetes mellitus: a review. Blood Cells Mol Dis 2008; 41: 119-123.
31. Ergelen M and Uyarel H. Plateletcrit: a novel prognostic marker for acute coronary syn-drome. Int J Cardiol 2014; 177: 161.
32. Jabeen F, Fawwad A, Rizvi HA and Alvi F. Role of platelet indices, glycemic control and hs-CRP in pathogenesis of vascular complications in type-2 diabetic patients. Pak J Med Sci 2013; 29: 152-156.
33. Erdogan S, Ozdemir O, Dogan HO, Sezer S, Atalay CR, Meric F, Yilmaz FM and Koca Y. Liver enzymes, mean platelet volume, and red cell distribution width in gestational diabetes. Turk J Med Sci 2014; 44: 121-125.
34. Citirik M, Beyazyildiz E, Simsek M, Beyazyildiz O and Haznedaroglu IC. MPV may reflect sub¬cinical platelet activation in diabetic patients with and without diabetic retinopathy. Eye (Lond) 2014; 29: 376-9.
35. Gasparyan AY, Ayvazyan L, Mikhailidis DP and Kitas GD. Mean platelet volume: a link be¬tween thrombosis and inflammation? Curr Pharm Des 2011; 17: 47-58.
36. Zuberi BF, Akhtar N and Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-dia¬betic subjects. Singapore Med J 2008; 49: 114-116.
37. Hekimsoy Z, Payzin B, Ornek T and Kandogan G. Mean platelet volume in Type 2 diabetic pa¬tients. J Diabetes Complications 2004; 18: 173-176.
38. Bavbek N, Kargili A, Kaftan O, Karakurt F, Kosar A and Akcay A. Elevated concentrations of soluble adhesion molecules and large plate¬lets in diabetic patients: are they markers of vascular disease and diabetic nephropathy? ClinApplThrombHemost 2007; 13: 391-397.
39. Tavil Y, Sen N, Yazici H, Turfan M, Hizal F, Cengel A and Abaci A. Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients. Platelets 2010; 21: 368-372.
40. Xiao W, Huang Y, Dong J, Zhang X and Hu J. Relationship between platelet volume indices with macrovascular and peripheral neuropathy complications in type 2 diabetic patients. J Diabetes 2014; 6: 298-303.
41. Lippi G, Salvagno GL, Nouvenne A, Meschi T, Borghi L and Targher G. The mean platelet vol¬ume is significantly associated with higher gly¬cated hemoglobin in a large population of un¬selected outpatients.Prim Care Diabetes 2015; 9: 226-30.
42. Bekler A, Ozkan MT, Tenekecioglu E, Gazi E, Yener AU, Temiz A, Altun B, Barutcu A, Erbag G and Binnetoglu E. Increased Platelet Dis-tribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome. Angiology 2014; 66: 638-43
43. Jindal S, Gupta S, Gupta R, Kakkar A, Singh HV, Gupta K and Singh S. Platelet indices in diabe¬tes mellitus: indicators of diabetic microvascu¬lar complications. Hematology 2011; 16: 86-89.
44. Erdogan S, Ozdemir O, Dogan HO, Sezer S, Atalay CR, Meric F, Yilmaz FM and Koca Y. Liver enzymes, mean platelet volume, and red cell distribution width in gestational diabetes. Turk J Med Sci 2014; 44: 121-125.
Published
2019-03-26
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