Components of the Complete Blood Count in Type 2 Diabetes Mellitus with Inadequate Glycemic Control

Year 2018, Volume: 45 Issue: 2, 113 - 120, 15.06.2018

Muhammed Kizilgul , Erkam Sencar Bekir Ucan Selvihan Beysel Ozgur Ozcelik Mustafa Ozbek Erman Cakal

https://doi.org/10.5798/dicletip.410811

Cited By: 15

Abstract

Objective:
Inadequate control of glycemia in diabetic patients is the primary cause of
both micro- and macrovascular complications. Several components of complete
blood count were investigated and have found to be higher in diabetic patients.
We aimed to evaluate white blood cell (WBC), neutrophil, lymphocyte and
platelet counts and, red cell distribution width (RDW), mean platelet volume
(MPV) and platelet distribution width (PDW) in type 2 diabetes mellitus (T2DM)
patients with inappropriorate glycemic management (HbAlc >7%) despite using insulin
therapy.

Methods: 135
type 2 diabetic patients with inappropriorate blood glucose management (HbAlc
value >7 %) despite using insulin therapy for at least 3-month period (only
insulin or insulin plus oral hypoglycemic agents) and 121 healthy subjects were
included in the study. Demographic, anthropometric and laboratory data were
recorded.

Results:
WBC, neutrophil, lymphocyte and monocyte counts were higher in DM group
(p<0.0001). WBC counts were positively correlated with diastolic blood
pressure (DBP), body mass index (BMI), waist circumference (WC) and
high-sensitive C- reactive protein (hsCRP), fasting plasma glucose (FPG), post-prandial
glucose (PPG), HbA1c and triglyceride levels (p<0.05). Neutrophil counts
were positively correlated with hsCRP, FPG, HbA1c, BMI, PPG, LDL-Cholesterol
(LDL-C) and microalbumin levels (p<0.05). Lymphocyte counts were positively
correlated with systolic blood pressure (SBP), DBP, BMI, WC and FPG, HbA1c,
LDL-C and triglyceride levels (p<0.05). WBC, neutrophil and lymphocyte
counts were negatively correlated with HDL-Cholesterol (HDL-C) levels
(p<0.05). PDW was higher in DM group (16.65±0.59 to 16.51±0.51, p:0.043).
PDW was positively correlated with age, DBP, FPG, PPG, HbA1c, LDL-C and
triglyceride levels (p<0.05). Monocyte to HDL-C ratio was higher in DM group
(13.50 ± 5.34 to 10.54 ± 4.29, p<0.0001).

Conclusions:
In this study white blood cell, neutrophil and lymphocyte counts and PDW were higher
in type 2 diabetic patients with inappropriorate glycemic management despite
insulin therapy and they were correlated wıth cardio-metabolic risk factors. Leukocyte
subtypes and PDW may be used as a marker for cardiovascular diseases in these
patients.

Keywords

Type 2 diabetes mellitus, complete blood count indices

References

• 1. Guariguata L. By the numbers: New estimates from the IDF Diabetes Atlas Update for 2012. Diabetes Res Clin Pract 2012;98:524–5.
• 2. Koro CE, Bowlin SJ, Bourgeois N, et al. Glycemic Control From 1988 to 2000 Among U.S. Adults Diagnosed With Type 2 Diabetes. Diabetes Care 2004;27:17–20.
• 3. Matheus a S, Tannus LR, Cobas R a, et al. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens 2013;2013:653789.
• 4. Libby P. Inflammation in atherosclerosis. Nature 2002;420:868–74.
• 5. Madjid M, Awan I, Willerson JT, et al. Leukocyte count and coronary heart disease: Implications for risk assessment. J Am Coll Cardiol 2004;44:1945–56.
• 6. Barbieri J, Fontela PC, Winkelmann ER, et al. Anemia in Patients with Type 2 Diabetes Mellitus. Anemia 2015;2015:354737.
• 7. Gkrania-Klotsas E, Ye Z, Cooper AJ, et al. Differential white blood cell count and type 2 diabetes: Systematic review and meta-analysis of cross-sectional and prospective studies. PLoS One 2010;5:e13405.
• 8. Hekimsoy Z, Payzin B, Ornek T, et al. Mean platelet volume in Type 2 diabetic patients. J Diabetes Complications 2004;18:173–6.
• 9. Tong PC, Lee KF, So WY, et al. White blood cell count is associated with macro- and microvascular complications in Chinese patients with type 2 diabetes. Diabetes Care 2004;27:216–22.
• 10. Wheeler JG, Mussolino ME, Gillum RF, et al. Associations between differential leucocyte count and incident coronary heart disease: 1764 Incident cases from seven prospective studies of 30 374 individuals. Eur Heart J 2004;25:1287–92.
• 11. Nada AM. Red cell distribution width in type 2 diabetic patients. Diabetes, Metab Syndr Obes Targets Ther 2015;8:525–33.
• 12. Chen X, Fang L, Lin H, Shen P, Zhang T, Li H, Li X, Yu M, Xu C, Zhang J, Lu F, DU X, Hu R ZJ. The Relationship between Type 2 Diabetes and Platelet Indicators. Iran J Public Heal 2017;46:1211–6.
• 13. Zhang Y, Li S, Guo Y-L, et al. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography. Ann Med 2016;48:305–12.
• 14. Cetin MS, Ozcan Cetin EH, Kalender E, et al. Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome. Hear Lung Circ 2016;25:1077–86.
• 15. Pickup JC, Mattock MB, Chusney GD, et al. NIDDM as a disease of the innate immune system: association of acute-phase reactants and interleukin-6 with metabolic syndrome X. Diabetologia 1997;40:1286–92.
• 16. Duncan BB, Schmidt MI, Pankow JS, et al. Low-Grade Systemic Inflammation and the Development of Type 2 Diabetes: The Atherosclerosis Risk in Communities Study. Diabetes 2003;52:1799–805.
• 17. Schmidt MI, Duncan BB, Sharrett a R, et al. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet 1999;353:1649–52.
• 18. Vozarova B, Weyer C, Lindsay RS, et al. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002;51:455–61.
• 19. Mulvihill NT, Foley JB. Inflammation in acute coronary syndromes. Heart 2002;87:201–4.
• 20. Merten M, Thiagarajan P. P-selectin expression on platelets determines size and stability of platelet aggregates. Circulation 2000;102:1931–6.
• 21. Rana JS, Boekholdt SM, Ridker PM, et al. Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: The EPIC-Norfolk Prospective Population Study. J Intern Med 2007;262:678–89.
• 22. Shah AD, Denaxas S, Nicholas O, et al. Neutrophil Counts and Initial Presentation of 12 Cardiovascular Diseases: A CALIBER Cohort Study. J Am Coll Cardiol 2017;69:1160–9.
• 23. Verdoia M, Schaffer A, Barbieri L, Aimaretti G, Marino P, Sinigaglia F, Suryapranata H DLGNASG (NAS). Impact of diabetes on neutrophil-to-lymphocyte ratio and its relationship to coronary artery disease. Diabetes Metab 2015;41:304–11.
• 24. Yilmaz H, Ucan B, Sayki M, et al. Usefulness of the neutrophil-to-lymphocyte ratio to prediction of type 2 diabetes mellitus in morbid obesity. Diabetes Metab Syndr Clin Res Rev 2015;9:299–304.
• 25. Van der Loo B, Martin JF. Megakaryocytes and platelets in vascular disease. Baillieres Clin Haematol 1997;10:109–23.
• 26. Ferroni P, Basili S, Falco a, et al. Platelet activation in type 2 diabetes mellitus. J Thromb Haemost 2004;2:1282–91.
• 27. Zuberi BF, Akhtar N, Afsar S. Comparison of mean platelet volume in patients with diabetes mellitus, impaired fasting glucose and non-diabetic subjects. Singapore Med J 2008;49:114–6.
• 28. Papanas N, Symeonidis G, Maltezos E, et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2004;15:475–8.
• 29. Buch A, Kaur S, Nair R, et al. Platelet volume indices as predictive biomarkers for diabetic complications in Type 2 diabetic patients. J Lab Physicians 2017;9:84.
• 30. Perlstein TS, Weuve J, Pfeffer MA, et al. Red Blood Cell Distribution Width and Mortality Risk in a Community-Based Prospective Cohort. Arch Intern Med 2009;169:588.
• 31. Zalawadiya SK, Zmily H, Farah J, et al. Red cell distribution width and mortality in predominantly African-American population with decompensated heart failure. J Card Fail 2011;17:292–8.
• 32. Patel K V., Ferrucci L, Ershler WB, et al. Red Blood Cell Distribution Width and the Risk of Death in Middle-aged and Older Adults. Arch Intern Med 2009;169:515.
• 33. Hansson GK. Innate and Adaptive Immunity in the Pathogenesis of Atherosclerosis. Circ Res 2002;91:281–91.
• 34. Olivares R, Ducimetière P, Claude JR. Monocyte count: a risk factor for coronary heart disease? Am J Epidemiol 1993;137:49–53.
• 35. Gratchev A, Sobenin I, Orekhov A, et al. Monocytes as a diagnostic marker of cardiovascular diseases. Immunobiology 2012;217:476–82.
• 36. Barter PJ, Baker PW, Rye K-A. Effect of high-density lipoproteins on the expression of adhesion molecules in endothelial cells. Curr Opin Lipidol 2002;13:285–8.
• 37. Murphy AJ, Woollard KJ, Hoang A, et al. High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol 2008;28:2071–7.