|Year : 2019 | Volume
| Issue : 1 | Page : 24-30
Assessment of the alteration of blood indices in patients with type 2 diabetic mellitus: A cross-sectional study
Mohammad Hasan Ali, Abeer J Hassan
Department of Community Health, Medical Technology Institute of Baghdad, Middle Technical University, Baghdad, Iraq
|Date of Web Publication||10-May-2019|
Dr. Mohammad Hasan Ali
Department of Community Health, Medical Technology Institute of Baghdad, Middle Technical University, Baghdad
Source of Support: None, Conflict of Interest: None
Background: The prevalence of diabetes mellitus has a major impact on national and global health. Diabetes, a noncommunicable disease, was considered one of the top ten causes of death. Diabetic patients with chronic hyperglycemia have increased risk of macrovascular and microvascular complications in the long term. Diabetes is associated with an increased risk for morbidity from anemia which leads to dysfunction and structural change in all formed elements. Objective: This study focused on the alteration of blood parameters in diabetic patients compared with healthy controls. Materials and Methods: This is a comparative study including 230 patients treated at a specialized center for endocrinology and diabetes from December 2017 to January 2018. Of the total 230 diabetic patients enrolled in this study, 46 were male and 184 were female, their age range was 20–70 years, and they were compared with 100 healthy individuals that served as control group. A questionnaire was administered as data collection form. Body mass index was estimated. Fasting blood glucose, HbA1c, and formed element indices were laboratory investigated and analyzed by using autohematology analyzer (Huroba ABX). Data were statistically analyzed using SPSS software version 17. Results: The results of the current study revealed that there were statistically significant differences in blood parameters such as red blood cell (RBC) and white blood cell (WBC) count, mean cell volume (MCV) level, and red cell distribution width (RDW) level (P ≤ 0.05), whereas no significant differences were recorded in RBC (hemoglobin, hematocrit, mean cell hemoglobin [MHC], and MCH concentration) and platelet (platelet count, MPV, and PDW) parameters (P ≥ 0.05) when compared with the control group. Conclusions: The present study concluded that blood parameters such as RBCs, MCV, RDW, and WBCs are significantly higher among diabetic patients.
Keywords: Control group, diabetes mellitus, formed element indices
|How to cite this article:|
Ali MH, Hassan AJ. Assessment of the alteration of blood indices in patients with type 2 diabetic mellitus: A cross-sectional study. Mustansiriya Med J 2019;18:24-30
|How to cite this URL:|
Ali MH, Hassan AJ. Assessment of the alteration of blood indices in patients with type 2 diabetic mellitus: A cross-sectional study. Mustansiriya Med J [serial online] 2019 [cited 2019 May 23];18:24-30. Available from: http://www.mmjonweb.org/text.asp?2019/18/1/24/257903
| Introduction|| |
According to the global estimates of the prevalence of diabetes in 2017, 451 million (age: 18–99 years) people are suffering from diabetes. These statistics were expected to elevate to 693 million by 2045. It has been reported that almost half of all people (49.7%) living with diabetes (asymptomatic disease) are left undiagnosed. According to the global health estimates 2016, diabetes mellitus (DM) has been considered as one among the leading ten causes of death in low-, middle-, and upper-income countries.
Nationally, Iraq is one of the 19 countries and territories of the International Diabetes Federation Middle East and North African region. There were 1411.5 cases of diabetes in Iraq in 2017.
DM is a symptomatic disease characterized by chronic hyperglycemia. It arises because of dysfunction of insulin secretion or dysfunction of insulin action, or both. Individuals with chronic or acute diabetes, particularly those with type 2 diabetes, are at an increased risk for myocardial infarction, stroke, and hematological disease. The effects of metabolic products such as toxic chemical compounds and foreign bodies on the blood cell structure often result in change in blood parameter indices, especially, in red blood cell (RBC) indices which causes decrease in the number of erythrocytes or reduction of hemoglobin concentration, which in turn leads to different types of anemia. White blood cells (WBCs) play an important role in immunity functions and phagocytic action to defend the body against foreign bodies and microorganisms. Platelets (thrombocytes) have a basic role in hemostasis to stop bleeding and coagulation. The formed elements in medical term refer to all the blood cells, cell remnants, and cell fragments.
Several studies in diabetic patients demonstrated that persistent hyperglycemia can contribute to the formation of glycation products that perform free radical damage and increase oxidative stress. Furthermore, free radicals damage the cell DNA and causes cell apoptosis, besides hyperglycemia produce pro-inflammatory cytokines as well as advanced glycation end products. The metabolic products from diabetic and various diabetic complication is interaction with blood components and alter physiological function of blood parameters. Therefore assessment of formed element indices can be making decision for the management and treatment of diabetic complication.
Hematological abnormality such as low or elevated RBCs and hemoglobin can give indicator for anemia or polycythemia. There is a positive correlation between packed cell volume (PCV) and hemoglobin and RBCs indices and anemia in old patients. Other parameters such as mean cell volume (MCV), mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC) are calculated mathematically to reflect the concentration of hemoglobin and size of RBCs. Diabetes often impaired the immune system of the body. Leukocytosis was correlated to the severity of infection and reduce WBCs (leukopenia) correlated to inflammatory lesion.,, Platelets indices have a role in clotting factors and fibrinolysis activity specially in diabetic complication such as atherosclerosis and vascular disease.,
This study aimed to study the alteration of blood parameters in diabetic patients compared to healthy control.
| Materials and Methods|| |
A comparative, cross-sectional study was performed from December 2017 to January 2018. A total 230 patients were diagnosed with Type 2 diabetic mellitus compared with one hundred apparently healthy control subjects. Data were collected by using questionnaire and bio-information conduced in specialized center for endocrinology and diabetic in Baghdad city. All patients demographic features (age, sex, and residency) medical history, physical examination and anthropometric measurement such as body mass index were recorded for all subjects. Glycemic status investigated for fasting blood glucose (FPG) and HbA1c were estimated and analyzed by Bio-chemical (erauto) analyzer. Hematology auto analyzer (Huroba ABX) used to measure blood parameters such as Red cell indices, platelet indices and white blood cells (WBC) parameters (granulocytes and A granulocytes). Data were statistically analyzed using statistical package SPSS version 17 (New York, USA) in order to analyze and assess the results of study. Descriptive statistics table (frequencies and percentage), Pearson's correlation coefficients. Statistical hypotheses which include Chi-square, Fisher's exact probability, Levene test and odds ratio for control and study.
| Results|| |
[Table 1] shows the association between the two groups according to age, the result had been indicated that there was a nonsignificant differences at P > 0.05 for the distribution of age groups between the two samples. [Table 1] shows again the association between the two groups according to gender, the result had been indicated that there was a nonsignificant differences at P > 0.05 for the distribution of gender between the two samples rather than odd ratio (female/male) reported (1:1.33) times at the (study/control) samples respectively.
|Table 1: Distribution of the diabetic patients regarding gender and age (study and control)|
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[Table 2] shows the association between the different groups according to BMI, the result had been indicated that there was a nonsignificant difference at P > 0.05 for the distribution of BMI groups between the two samples. In the study group, BMI ranged between (17.0 and 57.0), as well as at control BMI ranged between (18.0 and 46.0).
|Table 2: Distribution of the diabetic patients regarding body mass index (study and control)|
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[Table 3] shows the follows:
|Table 3: Descriptive statistics of the studied parameters for the mean±standard deviation (95% confidence interval) (study and control)|
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- HbA1c parameter shows that with the study group, the mean value and 95% confidence interval (CI) of the population mean value fall outside of a normal range (4.5–7.0)% at the upstairs bound.
- Glucose parameter shows that with the study group, the mean value and 95% CI of the population mean value fall outside of a normal range (3.6–6.3) mmol/L at the upstairs bound
- All blood parameters show that with the study group, the mean value and 95% CI of the population mean value fall inside of a normal range Hb (12–16) g/dl, HCT (36–46) %, RBC (3.5–5.5) 106/mm3, MCV (80–100) μm3, MCH (27–32) pg, MCHC (32–36) g/dl, RDW (11–16) %, platelet (150–500) 102/mm3, and some of original readings were recorded abnormal values at the upper bound in both samples.
The results in [Table 4] represent the distribution of study patients compared with control groups according to the RBCs parameters; Hb level no significant (P = 0.6) and the ratio was reported (1:0.84). HCT% level was found no significant differences (P = 0.8) and the ratio was recorded (1:1.08). RBCs count a significant difference was found (P = 0.04) and the ratio was estimated (1:1.33). MCV value a significant difference was reported (P = 0.08) and the ratio was recorded (1:1.09). MCH level no significant differences was found (P = 0.79) and the ratio was recorded (1:0.92). MCHC level showed no significant differences (P = 0.15) when compared with the control group. RDW level statistically a significant difference was found (P = 0.03) and the ratio was recorded (1:2.024).
|Table 4: Distribution of the diabetic patients regarding the red blood cells indices tests compared with control groups|
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Result in [Table 5] regarding platelet count no significant differences was demonstrated (P = 0.17) and the ratio was reported (1:0.336). PDW level showed no significant differences (P = 0.19) when compared with the control group. MPV level showed no significant differences (P = 0.18) when compared with the control group.
|Table 5: Distribution of the diabetic patients regarding the platelet indices tests compared with control groups|
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Result in [Table 6] regarding WBCs count a significant difference was found (P = 0.04) and the ratio was estimated (1:0.93).
|Table 6: Distribution of the diabetic patients regarding the white blood cell count tests compared with control groups|
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| Discussion|| |
The result in this study had been indicated that there was a nonsignificant differences at P > 0.05 for the distribution of gender, age and BMI at the (study/control) samples. The result in the present study showed statistically significant differences in RBCs, WBCs count, MCV level and RDW level (P < 0.05) while no significant differences was recorded in others parameters (P > 0.05). This finding is in agreement with several studies.,,, Study made by Shukla et al. found higher level of total RBCs, PCV and platelets in patients with hypertensive diabetic. Others studies agreement with this results.,, Study performed by Kumar et al. showed lower significant results in diabetics RBCs, MCV, Hb and PCV than nondiabetic. Whereas WBC count was higher in diabetes compared with nondiabetic. Similar results observed in others studies., The presence of biochemical and metabolic products in diabetic patients lead to elevated level of red cell indices indicated to develop of micro and macro-vascular complication and causes different severity of anemia due to reduce erythrocytes life span, blood viscosity and RBCs deformability.,
| Conclusion|| |
The present study concluded that blood parameters RBCs, MCV, RDW, and WBCs are significantly higher among diabetic patients.
Screening and good diabetic management are help to prevent diabetic complications and develop anemia.
I am grateful to all members of the medical laboratory for their support and cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Al-Kuraishy HM, Al-Gareeb AI, Monteiro MC, Al-Windy SA, Jaber H. Salivary nitrite in patients with type 2 diabetes mellitus: Role of diabetic pharmacotherapy. Glob J Pharm Sci 2017;1:555558. DOI: 10.19080/GJPPS.2017.01.555558.
Al-Kuraishy HM, Al-Gareeb AI. Erectile dysfunction and low sex drive in men with type 2 DM: The potential role of diabetic pharmacotherapy. J Clin Diagn Res 2016;10:FC21-6.
Al-Kuraishy HM, Al-Gareeb AI, Waheed HJ, Al-Maiahy TJ. Differential effect of metformin and/or glyburide on apelin serum levels in patients with type 2 diabetes mellitus: Concepts and clinical practice. J Adv Pharm Technol Res 2018;9:80-6.
] [Full text]
Alkuraishy HM, Al-Gareeb AI. New insights into the role of metformin effects on serum omentin-1 levels in acute myocardial infarction: Cross-sectional study. Emerg Med Int 2015;2015:283021.
Al-Kuraishy HM, Al-Gareeb AI, Al-Buhadilly AK. Rosuvastatin improves vaspin serum levels in obese patients with acute coronary syndrome. Diseases 2018;6. pii: E9.
Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JPA, et al.
Effect of low-fat vs. low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: The DIETFITS randomized clinical trial. JAMA 2018;319:667-79.
Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al.
Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. Lancet 2018;391:541-51.
Gulati S, Misra A. Abdominal obesity and type 2 diabetes in Asian Indians: Dietary strategies including edible oils, cooking practices and sugar intake. Eur J Clin Nutr 2017;71:850-7.
Winkelman JW, Tanasijevic MJ, Zahniser DJ. A novel automated slide-based technology for visualization, counting, and characterization of the formed elements of blood: A proof of concept study. Arch Pathol Lab Med 2017;141:1107-12.
Winkelman J, Tanasijevic M, Zahniser D. Method for Determining a Complete Blood Count on a White Blood Cell Differential Count. US Patent 8815537. Roche Diagnostics Hematology Inc.; 2014.
Tortora GJ, Derrickson B. Principle of Anatomy and Physiology. 13rd
ed., Vol. 2. Ch. 19. Asia: John Wiley and Sons, Inc., PTE Ltd.; 2011. p. 229.
Al-Kuraishy HM, Al-Gareeb AI. Comparison of deferasirox and deferoxamine effects on iron overload and immunological changes in patients with blood transfusion-dependent β-thalassemia. Asian J Transfus Sci 2017;11:13-7.
] [Full text]
Eze ED, Mohammed A, Tanko Y, Ahmed A, Rabiu KM. Hypoglycaemic effect of lycopene in streptozotocin-induced diabetic Wistar rats. British Journal of Medicine and Medical Research 2015;7:762-70.
Bradbury C, Murray J. Investigating an incidental finding of thrombocytopenia. BMJ 2013;346:f11.
Barbieri J, Fontela PC, Winkelmann ER, Zimmermann CE, Sandri YP, Mallet EK, et al.
Anemia in patients with type 2 diabetes mellitus. Anemia 2015;2015:354737.
Moradi S, Kerman SR, Rohani F, Salari F. Association between diabetes complications and leukocyte counts in Iranian patients. J Inflamm Res 2012;5:7-11.
Nada AM. Red cell distribution width in type 2 diabetic patients. Diabetes Metab Syndr Obes 2015;8:525-33.
Hudzik B, Szkodziński J, Lekston A, Gierlotka M, Poloński L, Gąsior M, et al.
Mean platelet volume-to-lymphocyte ratio: A novel marker of poor short – And long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. J Diabetes Complications 2016;30:1097-102.
Biadgo B, Melku M, Abebe SM, Abebe M. Hematological indices and their correlation with fasting blood glucose level and anthropometric measurements in type 2 diabetes mellitus patients in Gondar, Northwest Ethiopia. Diabetes Metab Syndr Obes 2016;9:91-9.
Chen LK, Lin MH, Chen ZJ, Hwang SJ, Chiou ST. Association of insulin resistance and hematologic parameters: Study of a middle-aged and elderly Chinese population in Taiwan. J Chin Med Assoc 2006;69:248-53.
Al-Kuraishy HM, Al-Gareeb AI. Effects of rosuvastatin alone or in combination with omega-3 fatty acid on adiponectin levels and cardiometabolic profile. J Basic Clin Pharm 2016;8:8-14.
Al-Gareeb AI, Aljubory KD, Alkuraishy HM. Niclosamide as an anti-obesity drug: An experimental study. Eat Weight Disord 2017;22:339-44.
Shukla DK, Chandra KP, Pawah AK. Study of hematological indices in patients with diabetes mellitus and hypertensive diabetes mellitus. Indian J Med Res 2016;1:28-31.
Jabeen F, Rizvi HA, Subhan A. Effect of hyperglycemia onsuperoxide dismutase defensesystem and erythrocyteindices in diabetic patients. Pak J Biochem Mol Biol 2012;45:85-9.
Kodiatte TA, Manikyam UK, Rao SB, Jagadish TM, Reddy M, Lingaiah HK, et al.
Mean platelet volume in type 2 diabetes mellitus. J Lab Physicians 2012;4:5-9.
] [Full text]
Alam MJ, Mallik SC, Mukti NM, Hoque MM, Hasan M, Islam MS, et al
. A comparative analysis of biochemical and hematological parameters in diabetic and non-diabetic adults. Adv Med Sci 2015;2:1-9.
Harish Kumar S, Srinivasa SV, Prabhakar K. Haematological profile of diabetes and non-diabetes patients in rural tertiary centre. Int J Adv Med 2017;4:1271-5.
Al Salhen KS, Mahmoud AY. Hematological profile of patients with type 2Diabetic mellitus in El-Beida, Libya. Ibnosina J Med Biomed Sci 2017;9:76-80.
Edet EE, Akpanabiatu MI, Uboh FE, Edet TE, Eno AE, Itam EH, et al
. Gongronema latifolium crude leaf extract reverses alterations in hematological indices and weight loss in diabetic rats. J Pharmacol Toxicol 2011;6:174-81.
Al-Kuraishy HM, Al-Gareeb AI. Effect of orlistat alone or in combination with Garcinia cambogia
on visceral adiposity index in obese patients. J Intercult Ethnopharmacol 2016;5:408-14.
Al-Kuraishy HM, Al-Gareeb AI, Al-Buhadilly AK. Vinpocetine and pyritinol: A new model for blood rheological modulation in cerebrovascular disorders – A randomized controlled clinical study. Biomed Res Int 2014;2014:324307.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]