Platelet function in patients with diabetes mellitus: from a theoretical to a practical perspective

Hematological parameters of newborns from diabetic mothers in Gandhi memorial hospital, Addis Ababa, Ethiopia

BACKGROUND

Diabetes mellitus during pregnancy can significantly affect a newborn's hematological profile. However, the hematological profiles among newborns of diabetic mothers and their clinical and prognostic implications are not well explored. Therefore, this study aimed to determine hematological parameters of newborns from diabetic mothers in Gandhi Memorial Hospital, Addis Ababa, Ethiopia, 2024.

METHODS

A comparative cross-sectional study was carried out at Gandhi Memorial Hospital from March to May 2024. A total of 196 newborns -98 from diabetic mothers and 98 from apparently healthy mothers-were conveniently enrolled in the study. A hematological profile test was assayed using a Sysmex XN-550 analyzer from the whole blood of mothers and cord blood of newborns collected in EDTA. Glucose was measured using a Cobas C311 analyzer from serum collected using SST test tube. Data was entered and analyzed using SPSS version 26, with descriptive statistics, proportions, and independent t-tests. A P-value of less than 0.05 was considered statistically significant.

RESULTS

The study found that the mean ± SD value of red blood cell count was 4.87 ± 0.68 vs 3.33 ± 0.98 x1012/L (P < 0.001), hemoglobin 17.48 ± 2.69 vs 12.08 ± 3.48 g/dL (P < 0.001), hematocrit 49.83 ± 7.47 vs 36.13 ± 8.97% (P < 0.001), red cell distribution width 18.35 ± 2.68 vs 17.27 ± 1.92% (P < 0.001), platelet distribution width 12.26 ± 1.80 vs 11.69 ± 1.76% (P = 0.028), and platelet large cell ratio was 26.05 ± 5.27 vs 24.07 ± 2.21% (P = 0.001) were significantly higher in newborns born to diabetic mothers compared to controls. Polycythemia was seen in large numbers in newborns born to diabetic mothers (56.1%, 55/98 vs 1%, 1/98). On the other hand, the platelet count and PCT values were significantly lower in newborns from diabetic mothers than controls, with a mean value of 239.69 ± 92.52 (103/µL) and 0.24 ± 0.09 (%), respectively, with a P value < 0.001.

CONCLUSION

The hematological profile shows a significant difference among newborns from mothers with diabetes and apparently healthy mothers. Therefore, it is better to consider hematological parameters as a screening tool for early detection of hematological complications in newborns from diabetic mothers, and this screening should be encouraged.

Impact of chronic hyperglycaemia on the coronary microcirculation - benefits of targeting IL-36 and diet reversal

Following myocardial infarction (MI), patients with type 2 diabetes mellitus (T2DM) have poorer prognosis which may be linked to increased susceptibility of coronary microvessels to injury. Interleukin-36 (IL-36) may mediate this injury but its role in the microcirculation of the chronically hyperglycaemic injured heart is unknown. Intravital and laser speckle imaging of the anaesthetised mouse beating heart evaluated the impact of a 16-week high fat diet (HFD)-induced hyperglycaemia ± myocardial ischaemia-reperfusion injury (IR) injury on coronary microvessels. Neutrophil/platelet recruitment, neutrophil extracellular trap formation, cellular necrosis, vascular leakage, vascular tonal changes, functional capillary density, overall ventricular perfusion and levels of circulating inflammatory cytokines were assessed alongside the vasculoprotective ability of an IL-36 receptor antagonist (IL-36Ra). Whether heightened microvessel damage in injured HFD mice was permanent or reversible was investigated after normalising hyperglycaemia through diet reversal (DR). Microcirculatory events assessed were perturbed basally in HFD mice and further after injury. IL-36Ra mitigated these effects and improved infarct size. DR was also beneficial, decreasing neutrophil recruitment to levels below those seen in untreated mice. Mechanistically, benefits of both IL-36Ra and DR could be explained by decreased endothelial oxidative stress and VCAM-1 expression and possibly by raised levels of IL-4/IL-13. Basal changes in chronically hyperglycaemic coronary microvessels that are heightened in the aftermath of reperfusion may explain the poorer outcomes in MI patients with T2DM. These findings are the first to highlight the specific benefits of IL-36 inhibition and reversing hyperglycaemia through dietary modification on the coronary microcirculation in a preclinical model of T2DM.

The Effect of Colchicine on Platelet Function Profiles in Patients with Stable Coronary Artery Disease: The ECLIPSE Pilot Study

INTRODUCTION

This prospective, single-arm pharmacodynamic study assessed the effect of colchicine (COLC) [Strides Pharma UK Ltd, Watford, Hertfordshire, England] 0.5 mg administered orally once daily for 14 days on platelet reactivity with respect to aspirin reaction units (ARUs) and P2Y12 reaction units (PRUs).

METHODS

Twenty-two patients with stable coronary artery disease (CAD) on dual antiplatelet therapy (DAPT) with daily maintenance aspirin and clopidogrel were recruited. Baseline platelet function was evaluated with the VerifyNow™ ARU and PRU assays (Werfen, Bedford, MA, USA) and assessed post-completion of COLC 0.5 mg once daily for 14 days.

RESULTS

In this study, the median ARU baseline score was 463, and post-COLC it was 436, which was not statistically significant (p = 0.485). The mean difference in scores was -18.31 (95% confidence interval [CI] -74.34 to 37.71, p = 0.504). At baseline, 27.3% of the patients had "aspirin resistance" or were non-responders, compared to 13.6% post-COLC (p = 0.423). The median baseline PRU score was 210, and post-COLC it was 199, which was also not statistically significant (p = 0.581). The mean difference in scores was -7.31 (95% CI -31.1 to 16.5, p = 0.530). At baseline, 50% of the patients had "clopidogrel resistance" or were non-responders, compared to 45.5% post-COLC (p = 0.999). Two patients experienced mild gastrointestinal upset during the trial without interruption of COLC, and there were no serious adverse events or treatment-emergent adverse events.

CONCLUSIONS

There were no significant differences in ARUs and PRUs post-COLC trial in patients with stable CAD. This pilot pharmacodynamic study could be clinically informative in patients on DAPT. Further studies are required to confirm these exploratory findings.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT06567678, prospectively registered 20/8/2024.

Circulating microRNAs and physical activity: Impact in diabetes

The term "ci-miRNAs," or "circulating microRNAs," refers to extracellular microRNAs (miRNAs) that exist outside of cells and can be detected in various bodily fluids, including blood, saliva, urine, and breast milk. These ci-miRNAs play a role in regulating gene expression and are mainly recognized for their functions beyond the cell, serving as signaling molecules in the blood. Researchers have thoroughly investigated the roles of these circulating miRNAs in various diseases. The capacity to detect and quantify ci-miRNAs in bodily fluids suggests their potential as biomarkers for monitoring several health conditions, including cancer, heart disease, brain disorders, and metabolic disorders, where fluctuations in miRNA levels may correlate with different physiological and pathological states. Current methods enable researchers to identify and measure miRNAs in these fluids, facilitating the exploration of their roles in health maintenance and disease resistance. Although research on ci-miRNAs is ongoing, recent studies focus on uncovering their significance, assessing their viability as biomarkers, and clarifying their functions. However, our understanding of how various types, intensities, and durations of exercise influence the levels of these miRNAs in the bloodstream is still limited. This section seeks to provide an overview of the changes in ci-miRNAs in response to exercise.

Mechanistic insights of diabetic wound: Healing process, associated pathways and microRNA-based delivery systems

Wounds that represent one of the most critical complications can occur in individuals suffering from diabetes mellitus, and results in the need for hospitalisation and, in severe cases, require amputation. This condition is primarily characterized by infections, persistent inflammation, and delayed healing processes, which exacerbate the overall health of the patients. As per the standard mechanism, signalling pathways such as PI3K/AKT, HIF-1, TGF-β, Notch, Wnt/β-Cat, NF-κB, JAK/STAT, TLR, and Nrf2 play major roles in inflammatory, proliferative and remodelling phases of wound healing. However, dysregulation of the above pathways has been seen during the healing of diabetic wounds. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate the expression of various genes and signalling pathways which are associated with the process of wound healing. In the past few years, there has been a great deal of interest in the potential of miRNAs as biological agents in the management of a number of disorders. These miRNAs have been shown to modulate expression of genes involved in the healing process of wounds. There have been previous reviews pertaining to clinical trials examining miRNAs in several disorders, but only a few clinical studies have examined involvement of miRNAs in healing of wounds. Considering the therapeutic promise, there are several obstacles concerning their instabilities and inefficient delivery into the target cells. Therefore, this review is an attempt to discuss precise roles of signalling pathways and miRNAs in different phases of wound healing, and their aberrant regulation in diabetic wounds, particularly. It has also compiled a range of delivery mechanisms as well as an overview of the latest findings pertaining to miRNAs and associated delivery systems for improved healing of diabetic wounds.

Evaluation of Complete Blood Count Parameters in Patients With Diabetes Mellitus: A Systematic Review

Background and Aims

Several studies were performed to evaluate the relationship between CBC and patients with diabetes mellitus (DM). In this review, we discussed the prognostic value of CBC parameters in DM patients.

Methods

English literature was searched and retrieved from the Google Scholar search engine and PubMed database (1980-2024). "Diabetes mellitus," "Blood cell count," "Mean platelet volume," "Leukocytes," and "Inflammation" were used as keywords.

Results

DM increases vascular inflammation and oxidative stress, while vascular inflammation affects erythropoiesis and red blood cell deformation, thus increasing red cell distribution width (RDW). Mean platelet volume (MPV) is another useful prognostic biomarker for DM patients. Additionally, elevated neutrophil-lymphocyte ratio (NLR) levels are associated with poor glycemic control in T2DM patients, so it can be used as a screening tool in diabetic follow-up.

Conclusion

RDW can be used as a valuable independent biomarker to assess the prognosis of patients with DM. MPV can also be used as a noninvasive, widely available, and low-cost marker as a key factor as well as a Prognostic/diagnostic biomarker that could be used for DM patients. Total white blood cell count, NLR, Mean platelet volume lymphocyte ratio (MPVLR), and monocyte to high-density lipoprotein ratio (MHR) are valuable biomarkers in predicting DM.

Lipophilic index of serum phospholipids in patients with type 2 diabetes and atherosclerotic cardiovascular disease: links with metabolic control, vascular inflammation and platelet activation

BACKGROUND

Little is known about the mechanisms underlying the association of the serum phospholipid lipophilic index (LI) with atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes (T2D). Therefore, we investigated whether the LI is associated with glucometabolic control, meta-inflammation, thrombin generation, fibrin clot properties, endothelial function and platelet activation in T2D patients with angiographically documented ASCVD.

METHODS

We studied 74 T2D patients with ASCVD, aged 65.6 ± 6.8 years, with a median diabetes duration of 10 years and median HbA1c of 7.0%. Serum phospholipid fatty acids (FAs) were measured by gas chromatography. The serum phospholipid LI was calculated as the sum of the products of the proportion (% of total FAs) with the melting points (°C) of each individual FA, divided by the sum of the proportions of all FAs. Levels of HbA1c, insulin, leptin, adiponectin, lipid profiles, inflammatory markers (hsCRP, interleukin-6, TNF-α), Lp-PLA2 (a biomarker of vascular inflammation), endothelial function (sICAM-1, sVCAM-1, FMD, NMD), thrombin generation, fibrin clot properties and platelet activation, measured by light transmission aggregometry with arachidonic acid [AA] and adenosine diphosphate [ADP], were assessed.

RESULTS

Patients with LI > 16.9 °C (median) had higher HbA1c concentrations by 5.9% compared to the remaining subjects (p = 0.035). In this group, HbA1c levels ≥ 7.0% were found more often than in individuals with LI ≤ 16.9 °C (62.2 vs. 35.1%; p = 0.020). Subjects with LI > 16.9 °C had higher levels of TCh by 17.1% (p = 0.012), LDL-Ch by 29.4% (p = 0.003), interleukin-6 by 22.2% (p = 0.031) and Lp-PLA2 by 32.4% (p = 0.040), compared to the remaining patients. Moreover, they had increased maximal platelet aggregation induced by AA (p = 0.045), but not by ADP. Serum phospholipid LI correlated with HbA1c (r = 0.24; p = 0.037), TCh (r = 0.36; p = 0.002), LDL-Ch (r = 0.38; p < 0.001), interleukin-6 (r = 0.27; p = 0.020) and Lp-PLA2 (r = 0.26; p = 0.026). There were no intergroup differences in endothelial function, thrombin generation and fibrin clot properties. Regression analysis showed that HbA1c ≥ 7.0% and serum levels of LDL-Ch, interleukin-6 and Lp-PLA2 were predictors of LI > 16.9 °C in adjusted models.

CONCLUSIONS

In well-controlled T2D patients with ASCVD, the higher serum phospholipid LI is associated with worse glucometabolic control, enhanced vascular inflammation and higher platelet reactivity during aspirin treatment at cyclooxygenase-1-selective doses.

Periodontitis impacts on thrombotic diseases: from clinical aspect to future therapeutic approaches

Periodontitis is a chronic inflammatory disease initiated by biofilm microorganisms and mediated by host immune imbalance. Uncontrolled periodontal infections are the leading cause of tooth loss in adults. Thrombotic diseases can lead to partial or complete obstruction of blood flow in the circulatory system, manifesting as organ or tissue ischemia and necrosis in patients with arterial thrombosis, and local edema, pain and circulatory instability in patients with venous thrombosis, which may lead to mortality or fatality in severe case. Recent studies found that periodontitis might enhance thrombosis through bacterial transmission or systemic inflammation by affecting platelet-immune cell interactions, as well as the coagulation, and periodontal therapy could have a prophylactic effect on patients with thrombotic diseases. In this review, we summarized clinical findings on the association between periodontitis and thrombotic diseases and discussed several novel prothrombotic periodontitis-related agents, and presented a perspective to emphasize the necessity of oral health management for people at high risk of thrombosis.

Association between hematological indices and blood glucose level among patients with type 2 diabetes

BACKGROUND

Diabetes mellitus is a major health problem with a variety of implications: cellular, metabolic, and hematological. Hematological alterations observed in type 2 diabetes are related to hyperglycemia and have a vital role in vascular-associated diabetes complications which could be used as a marker for these complications. The aim of this study is to assess the association between hematological indices and blood glucose levels in patients with type 2 diabetes attending outpatient clinics in Mosul.

PATIENTS AND METHODS

A case-control study was done on 100 patients with type 2 diabetes and 100 healthy controls attending Alwafa Center for Diabetes and Endocrinology and four family medicine health centers in Mosul for the period 1st of January 2024-30th of March 2024. Data collection was done by a direct interview with participants. Hematological indices were tested by using an automatic hematology analyzer.

RESULTS

Statistically significant differences in Hb were found between diabetic patients and controls (P = 0.007). The total WBC count, neutrophils, and lymphocytes were significantly higher in diabetic patients compared to controls (P = 0.001 for all). Moreover, platelet indices (platelets count and PDW) showed a significant difference between diabetic patients and controls (P = 0.004 and 0.000) respectively. In addition, total WBC count, neutrophil count, and lymphocytes show a statistically significant positive correlation with FBS (P = 0.026, 0.050, and 0.019) respectively.

CONCLUSION

This study revealed statistically significant differences in various hematological parameters between patients with type 2 diabetes and healthy controls. Regular testing of hematological indices helps in early detection and proper management of diabetic complications.

Relationship Between Hematologic Inflammatory Markers and Glycemic Control in Type 2 Diabetes Mellitus Patients in a Tertiary Hospital in Nigeria

INTRODUCTION

Hematologic inflammatory biomarkers derived from a full blood count (FBC) are elevated in Type 2 diabetes mellitus (DM). In low- and middle-income countries like Nigeria, a FBC is an affordable and easily available test, even in rural areas. Glycated hemoglobin (HbA1c), a measure of glycemic control, has been found to correlate with hematologic inflammatory markers. In Nigeria, where health care is expensive and patients essentially pay out of pocket, a more affordable and accessible alternative to HbA1c in determining glycemic control is needed. Therefore, this study aimed to determine the relationship between Hb A1c and hematologic inflammatory biomarkers, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV), in predicting glycemic control.

METHODS

This was a six-month study of 109 patients with Type 2 DM in a tertiary hospital in Lagos. The patients' HbA1c and FBC were measured. NLR, PLR, and MPV were derived from the FBC values. We categorized the patients based on glycemic control. Spearman correlation analysis was used to determine the relationship between HbA1c and the inflammatory biomarkers.

RESULTS

There was no significant difference in NLR, PLR, and MPV between optimal and suboptimal controlled diabetic patients. Spearman's correlation analysis showed no significant association between NLR, PLR, MPV, and HbA1c in the patients (NLR: r=0.027, P=0.680; PLR: r=-0.091, P=0.356; MPV: r=-0.032, P=0.744).

CONCLUSION

The inflammatory markers studied had no significant relationship with HbA1c and might not help monitor glycemic control in Type 2 DM patients.

Correlation of Albumin, Red Cell Distribution Width and Other Biochemical and Hematological Parameters with Glycated Hemoglobin in Diabetic, Prediabetic and Non-Diabetic Patients

Diabetes mellitus is a chronic metabolic disease that affects more than 10.5% of the world's adult population. Biochemical and hematological parameters, such as albumin (ALB) and red cell distribution width (RDW), have been shown to be altered in diabetic patients. This study aimed to correlate hematological and biochemical parameters with glycated hemoglobin (HbA1c). A total of 777 adults (372 women and 405 men, aged 19-85 years) were divided into three groups: 218 participants with HbA1c < 5.7% (group A: non-diabetic), 226 with HbA1c ≥ 5.7% and <6.5% (group B: prediabetic) and 333 with HbA1c ≥ 6.5% (group C: diabetic). Biochemical and hematological parameters were compared among the three groups. An analysis of variance was performed to determine the correlations of the parameters among the groups. The ALB and sodium (Na) levels were significantly lower in group C than in groups A (ALB: 3.8 g/dL vs. 4.1 g/dL, p < 0.0001, Na: 138.4 mmol/L vs. 139.3 mmol/L, p < 0.001) and B (ALB: 3.8 g/dL vs. 4.0 g/dL, p < 0.0001, Na: 138.4 mmol/L vs. 139.6 mmol/L, p < 0.0001), whereas the RDW-standard deviation (RDW-SD) and urea were increased in group C as compared to group A (RDW: 45.8 vs. 43.9 fL, p < 0.0001, urea: 55.6 mg/dL vs. 38.5 mg/dL, p < 0.0001). The mean platelet volume (MPV) was increased in group C as compared to group A (9.3 fL vs. 9.1 fL, p < 0.05, respectively). Τhe increase in RDW-SD in group A as compared to B and C demonstrates the impact of hyperglycemia on red blood cells. Albumin and RDW might improve risk assessment for the development of diabetes. These results highlight the potential role of these parameters as an indication for prediabetes that would alert for measurement of HbA1c.

Multiparameter phenotyping of platelets and characterization of the effects of agonists using machine learning

Background

Platelet function is driven by the expression of specialized surface markers. The concept of distinct circulating subpopulations of platelets has emerged in recent years, but their exact nature remains debatable.

Objectives

To design a spectral flow cytometry-based phenotyping workflow to provide a more comprehensive characterization, at a global and individual level, of surface markers in resting and activated healthy platelets, and to apply this workflow to investigate how responses differ according to platelet age.

Methods

A 14-marker flow cytometry panel was developed and applied to vehicle- or agonist-stimulated platelet-rich plasma and whole blood samples obtained from healthy volunteers, or to platelets sorted according to SYTO-13 (Thermo Fisher Scientific) staining intensity as an indicator of platelet age. Data were analyzed using both user-led and independent approaches incorporating novel machine learning-based algorithms.

Results

The assay detected differences in marker expression in healthy platelets, at rest and on agonist activation, in both platelet-rich plasma and whole blood samples, that are consistent with the literature. Machine learning identified stimulated populations of platelets with high accuracy (>80%). Similarly, machine learning differentiation between young and old platelet populations achieved 76% accuracy, primarily weighted by forward scatter, cluster of differentiation (CD) 41, side scatter, glycoprotein VI, CD61, and CD42b expression patterns.

Conclusion

Our approach provides a powerful phenotypic assay coupled with robust bioinformatic and machine learning workflows for deep analysis of platelet subpopulations. Cleavable receptors, glycoprotein VI and CD42b, contribute to defining shared and unique subpopulations. This adoptable, low-volume approach will be valuable in deep characterization of platelets in disease.

Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis

Background

Patients with type 2 diabetes mellitus (DM) comprise more than a quarter of all patients undergoing percutaneous coronary intervention and are at higher risk of adverse events. We sought to reexamine the optimal duration of dual antiplatelet therapy (DAPT) postpercutaneous coronary intervention in patients with DM.

Methods

We systematically included randomized controlled trials comparing any 2 of 1, 3, 6, and 12 months of DAPT that reported major adverse cardiovascular events (MACE), net adverse clinical events (NACE), bleeding, or stent thrombosis in DM, and performed a frequentist network meta-analysis. We also performed a sensitivity analysis of trials that exclusively enrolled patients with acute coronary syndrome.

Results

In 16 randomized controlled trials comprising 16,376 adults with DM, there was no significant difference in NACE, MACE, stent thrombosis, or major bleeding between pairwise comparisons of 1, 3, 6, and 12 months of DAPT, except for a signal for lower bleeding with 3 months of DAPT compared to 12 (risk ratio, 0.72; 95% CI, 0.51-0.99). Sensitivity analysis of trials that solely included acute coronary syndrome similarly showed no significant difference in MACE between 1, 3, 6, and 12 months of DAPT.

Conclusions

Our study found no meaningful difference in NACE or MACE between pairwise comparisons of 1, 3, 6, and 12 months of DAPT by study-level meta-analysis of patients with DM, with lower bleeding risk observed with 3 months than with 12 months of DAPT. This finding may provide clinicians greater flexibility to personalize patients' DAPT duration based on other non-DM comorbidities that might affect bleeding or thrombosis risk.

Challenges and opportunities in the management of type 2 diabetes in patients with lower extremity peripheral artery disease: a tailored diagnosis and treatment review

Lower extremity peripheral artery disease (PAD) often results from atherosclerosis, and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). Individuals with T2DM exhibit a more severe manifestation and a more distal distribution of PAD compared to those without diabetes, adding complexity to the therapeutic management of PAD in this particular patient population. Indeed, the management of PAD in patients with T2DM requires a multidisciplinary and individualized approach that addresses both the systemic effects of diabetes and the specific vascular complications of PAD. Hence, cardiovascular prevention is of the utmost importance in patients with T2DM and PAD, and encompasses smoking cessation, a healthy diet, structured exercise, careful foot monitoring, and adherence to routine preventive treatments such as statins, antiplatelet agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. It is also recommended to incorporate glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the medical management of patients with T2DM and PAD, due to their demonstrated cardiovascular benefits. However, the specific impact of these novel glucose-lowering agents for individuals with PAD remains obscured within the background of cardiovascular outcome trials (CVOTs). In this review article, we distil evidence, through a comprehensive literature search of CVOTs and clinical guidelines, to offer key directions for the optimal medical management of individuals with T2DM and lower extremity PAD in the era of GLP-1RA and SGLT2i.

The Effect of Physical Activity/Exercise on miRNA Expression and Function in Non-Communicable Diseases-A Systematic Review

Exercise may differently affect the expression of key molecular markers, including skeletal muscle and circulating miRNAs, involved in cellular and metabolic pathways' regulation in healthy individuals and in patients suffering from non-communicable diseases (NCDs). Epigenetic factors are emerging as potential therapeutic biomarkers in the prognosis and treatment of NCDs and important epigenetic factors, miRNAs, play a crucial role in cellular pathways. This systematic review aims to underline the potential link between changes in miRNA expression after different types of physical activity/exercise in some populations affected by NCDs. In June 2023, we systematically investigated the following databases: PubMed, MEDLINE, Scopus, and Web of Science, on the basis of our previously established research questions and following the PRISMA guidelines. The risk of bias and quality assessment were, respectively, covered by ROB2 and the Newcastle Ottawa scale. Of the 1047 records extracted from the initial search, only 29 studies were found to be eligible. In these studies, the authors discuss the association between exercise-modulated miRNAs and NCDs. The NCDs included in the review are cancer, cardiovascular diseases (CVDs), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (T2DM). We evidenced that miR-146, miR-181, miR-133, miR-21, and miRNA-1 are the most reported miRNAs that are modulated by exercise. Their expression is associated with an improvement in health markers and they may be a potential target in terms of the development of future therapeutic tools.

A circle of life: platelet and megakaryocyte cytoskeleton dynamics in health and disease

Platelets are blood cells derived from megakaryocytes that play a central role in regulating haemostasis and vascular integrity. The microtubule cytoskeleton of megakaryocytes undergoes a critical dynamic reorganization during cycles of endomitosis and platelet biogenesis. Quiescent platelets have a discoid shape maintained by a marginal band composed of microtubule bundles, which undergoes remarkable remodelling during platelet activation, driving shape change and platelet function. Disrupting or enhancing this process can cause platelet dysfunction such as bleeding disorders or thrombosis. However, little is known about the molecular mechanisms underlying the reorganization of the cytoskeleton in the platelet lineage. Recent studies indicate that the emergence of a unique platelet tubulin code and specific pathogenic tubulin mutations cause platelet defects and bleeding disorders. Frequently, these mutations exhibit dominant negative effects, offering valuable insights into both platelet disease mechanisms and the functioning of tubulins. This review will highlight our current understanding of the role of the microtubule cytoskeleton in the life and death of platelets, along with its relevance to platelet disorders.

Impact of Pretransplant C-Reactive Protein, Neutrophiles, Platelets, and Albumin Levels on Recipient Survival After Simultaneous Pancreas and Kidney Transplantation

BACKGROUND

Long-lasting diabetes mellitus type 1 and end-stage renal disease induce severe metabolic and immunologic deterioration. Pretransplant C-reactive protein (CRP) and albumin (ALB) levels impact kidney transplantation. We evaluated the effects of preoperative CRP, ALB, neutrophils (NEU), and platelet (PLT) counts on 1- and 5-year recipient survival after simultaneous pancreas and kidney transplantation (SPK).

METHODS

Among 103 SPK recipients, the parameters were as follows: CRP (mean: 4.5 ± 4.97 mg/L); NEU (mean: 5.12 ± 2.13 × 103/mm3); PLT (mean: 244 ± 84 × 103/mm3); ALB (mean 4.5 ± 0.75 g/dL) were obtained before transplantation. Cox regression, uni-, multivariate analysis for 1- and 5-year survivals were performed with 95% CIs, and the area under the receiver operating characteristic (ROC) curve (AUC) was assessed.

RESULTS

In Cox regression, ALB <3.65 g/dL significantly affected 1- and 5-year survivors with hazard ratios of 8 (95% CI, 1.5-38.28; P < .05) and 3.13 (95% CI, 1.45-6.73; P < .05), respectively. In univariate analysis, we found significantly decreased 1-year survival when PLT <180×103/mm3, ALB <3.65 g/dL, NEU >5.8×103/mm3 and CRP >2.25 mg/L with odds ratios (OR) of 6.75 (95% CI, 2.12-21.15); 4.05 (95% CI, 1.3-12.09); 2.97 (95% CI, 1.02-8.64) and 5.51 (95% CI, 1.67-18.19), respectively. Independent factors for 5-year survival were CRP, ALB, and PLT with OR of 4.72 (95% CI, 1.67-13.29), 3.31 (95% CI, 1.18-9.25), and 4.2 (95% CI, 1.39-12.68), respectively. In multivariate analysis, we built 2 models for 1-year survival. Model 1 (ALB+PLT) with ORs of 3.12 (95% CI, 0.97-10.07) and 5.55 (95% CI, 1.67-18.4); and model 2 (CRP+PLT) with ORs of 5.51 (95% CI, 1.5-17.3) and 4.3 (95% CI, 1.2-15.06), respectively. The AUC for models 1 and 2 were 0.74 and 0.759, respectively.

CONCLUSIONS

NEU, PLT, ALB, and CRP levels assessed before transplantation are independent factors for 1- and 5-year SPK recipient survival.

Relative Thrombus Burden Ratio Reveals Overproportioned Intraluminal Thrombus Growth-Potential Implications for Abdominal Aortic Aneurysm

Background: An intraluminal, non-occlusive thrombus (ILT) is a common feature in an abdominal aortic aneurysm (AAA). This study investigated the relative progression of ILT vs. AAA volume using a novel parameter, the so-called thrombus burden ratio (TBR), in non-treated AAAs. Parameters potentially associated with TBR progression were analyzed and TBR progression in large vs. small and fast- vs. slow-growing AAAs was assessed. Methods: This retrospective, single-center study analyzed sequential contrast-enhanced computed tomography angiography (CTA) scans between 2009 and 2018 from patients with an AAA before surgical treatment. Patients' medical data and CTA scans were analyzed at two given time points. The TBR was calculated as a ratio of ILT and AAA volume, and relative TBR progression was calculated by normalization for time between sequential CTA scans. Spearman's correlation was applied to identify morphologic parameters correlating with TBR progression, and multivariate linear regression analysis was used to evaluate the association of clinical and morphological parameters with TBR progression. Results: A total of 35 patients were included. The mean time between CT scans was 16 ± 15.9 months. AAA volume progression was 12 ± 3% and ILT volume progression was 36 ± 13%, resulting in a TBR progression of 11 ± 4%, suggesting overproportioned ILT growth. TBR progression was 0.8 ± 0.8% per month. Spearman's correlation verified ILT growth as the most relevant parameter contributing to TBR progression (R = 0.51). Relative TBR progression did not differ significantly in large vs. small and fast- vs. slow-growing AAAs. In the multivariate regression analysis, none of the studied factors were associated with TBR progression. Conclusion: TBR increases during AAA development, indicating an overproportioned ILT vs. AAA volume growth. The TBR may serve as a useful parameter, as it incorporates the ILT volume growth relative to the AAA volume, therefore combining two important parameters that are usually reported separately. Yet, the clinical relevance in helping to identify potential corresponding risk factors and the evaluation of patients at risk needs to be further validated in a larger study cohort.

Estimated Intake of Potassium, Phosphorus and Zinc with the Daily Diet Negatively Correlates with ADP-Dependent Whole Blood Platelet Aggregation in Older Subjects

The aggregation of blood platelets is the pivotal step that leads to thrombosis. The risk of thrombotic events increases with age. Available data suggest that minerals taken with diet can affect the course of thrombosis. However, little is known about the relationship between platelet aggregability and mineral intake with diet among elderly people. Thus, we evaluated the associations between the reactivities of platelets to arachidonic acid, collagen or ADP and the estimated quantities of minerals consumed as a part of the daily diet in 246 subjects aged 60-65 years (124 men and 122 women). The found simple (not-adjusted) Spearman's rank negative correlations are as follows: 1. arachidonate-dependent aggregation and the amounts of potassium, zinc, magnesium, phosphorus, iron, copper and manganese; 2. collagen-dependent aggregation and the amounts of potassium, phosphorus, iron and zinc; and 3. ADP-dependent aggregation and the amounts of potassium, phosphorus and zinc. The negative associations between ADP-dependent platelet reactivity and the amount of potassium, phosphorus and zinc and between collagen-dependent aggregability and the amount of phosphorus were also noted after adjusting for a bunch of cardiovascular risk factors. Overall, in older subjects, the intake of minerals with diet is negatively related to blood platelet reactivity, especially in response to ADP. Diet fortification with some minerals may possibly reduce the thrombotic risk among elderly patients.

Acute Antiplatelet Effects of an Oleocanthal-Rich Olive Oil in Type II Diabetic Patients: A Postprandial Study

Postprandial dysmetabolism is a common entity of type 2 diabetes mellitus (T2DM) and may act as a daily stressor of the already dysfunctional diabetic platelets. This study aims to investigate whether oleocanthal-rich olive oils (OO), incorporated into a carbohydrate-rich meal, can affect postprandial dysmetabolism and platelet aggregation. Oleocanthal is a cyclooxygenase inhibitor with putative antiplatelet properties. In this randomized, single-blinded, crossover study, ten T2DM patients consumed five isocaloric meals containing 120 g white bread combined with: (i) 39 g butter, (ii) 39 g butter and 400 mg ibuprofen, (iii) 40 mL OO (phenolic content < 10 mg/Kg), (iv) 40 mL OO with 250 mg/Kg oleocanthal and (v) 40 mL OO with 500 mg/Kg oleocanthal. Metabolic markers along with ex vivo ADP- and thrombin receptor-activating peptide (TRAP)-induced platelet aggregation were measured before and for 4 h after the meals. The glycemic and lipidemic response was similar between meals. However, a sustained (90-240 min) dose-dependent reduction in platelets' sensitivity to both ADP (50-100%) and TRAP (20-50%) was observed after the oleocanthal meals in comparison to OO or butter meals. The antiplatelet effect of the OO containing 500 mg/Kg oleocanthal was comparable to that of the ibuprofen meal. In conclusion, the consumption of meals containing oleocanthal-rich OO can reduce platelet activity during the postprandial period, irrespective of postprandial hyperglycemia and lipidemia.

Dysregulated coagulation system links to inflammation in diabetic kidney disease

Diabetic kidney disease (DKD) is a significant contributor to end-stage renal disease worldwide. Despite extensive research, the exact mechanisms responsible for its development remain incompletely understood. Notably, patients with diabetes and impaired kidney function exhibit a hypercoagulable state characterized by elevated levels of coagulation molecules in their plasma. Recent studies propose that coagulation molecules such as thrombin, fibrinogen, and platelets are interconnected with the complement system, giving rise to an inflammatory response that potentially accelerates the progression of DKD. Remarkably, investigations have shown that inhibiting the coagulation system may protect the kidneys in various animal models and clinical trials, suggesting that these systems could serve as promising therapeutic targets for DKD. This review aims to shed light on the underlying connections between coagulation and complement systems and their involvement in the advancement of DKD.

Effect of oral versus parenteral vitamin D3 supplementation on nuclear factor-κB and platelet aggregation in type 2 diabetic patients

Platelet hyperactivity is one of the key factors implicated in the development and progression of diabetic vascular complications. Activated platelets mediate leukocyte recruitment that further enhances inflammatory responses in vascular wall ultimately resulting in atherosclerotic complications. Since vitamin D insufficiency is highly prevalent in diabetics, we aimed to evaluate the effect of three dosage forms of vitamin D supplementation on lipid profile, NF-κB, platelet aggregation, and platelet calcium content in type 2 diabetic patients. Type 2 diabetic patients were randomized to receive daily (4000 IU/day) or weekly (50 000 IU/week) oral vitamin D3 for 3 months. Another group received a single parenteral dose (300 000 IU) of vitamin D3, whereas the control group received their antidiabetic drug(s) alone. Serum 25(OH)D, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, NF-κB, and platelet aggregation were measured at the beginning and 3 months after vitamin D supplementation. Platelet calcium content was evaluated by measuring the fluorescence intensity of Rhod-2-stained platelets by confocal fluorescence microscopy. Results showed that serum 25(OH)D3 levels significantly increased in all vitamin D3-treated groups. However, the mean level for parenteral treated group was significantly lower than oral-treated groups. Oral and parenteral treatment were also able to decrease NF-κB level, platelet aggregation, and platelet calcium content. However, both oral doses of vitamin D3 were superior to the single parenteral dose. In conclusion, restoring normal levels of vitamin D is an important determinant to maintain normal platelet function and reduce inflammation. Nevertheless, further long-term studies are still needed.

Insulin Resistance-Induced Platelet Hyperactivity and a Potential Biomarker Role of Platelet Parameters: A Narrative Review

Background

Insulin has an inhibitory effect on platelets; however, this is compromised in circumstances of Insulin Resistance (IR), leading to platelet hyperactivity. Platelet parameters such as mean platelet volume, platelet count, and platelet distribution width are simple and accessible potential biomarkers for the early diagnosis and prognosis of IR. Therefore, the aim of this review is to provide insight on the current status of knowledge regarding IR-induced platelet hyperactivation and the potential biomarker role of platelet parameters.

Methods

This narrative review included articles published in the English language. Searches were carried out at the electronic databases PubMed and Google Scholar. The search strategy was done by combining key words and related database-specific subject terms (Mesh terms) with the appropriate Boolean operators.

Conclusion

Increasing insulin sensitivity in insulin resistant patients would possibly cause substantial reduction in platelet activation, which in turn reduce complications related with platelet hyperactivation. The standard methods to measure IR are not frequently employed in clinical practice due to their expensiveness and complexity. Thus, early detection of IR using a simple and more widely available biomarkers such as mean platelet volume, platelet count and platelet distribution width would be beneficial. Particularly in developing countries where resource scarcity is a major constraint of the health sector, utilizing such easy and affordable biomarkers may have a crucial role.

Pharmacokinetic and Pharmacodynamic Interactions Between Henagliflozin, a Novel Selective SGLT-2 Inhibitor, and Warfarin in Healthy Chinese Subjects

PURPOSE

While controlling blood glucose, patients with diabetes and abnormal coagulation should be treated with positive anticoagulation because the hypercoagulable state of their blood is the primary cause of macroangiopathy. The goal of this study was to evaluate the pharmacokinetic and pharmacodynamic (PK/PD) interactions between henagliflozin, a novel selective sodium-glucose cotransporter 2 inhibitor, and warfarin in healthy subjects.

METHODS

This single-center, open-label, single-arm clinical study was conducted in 16 healthy male Chinese subjects. According to the study protocol, the PK properties of henagliflozin 10 mg/d and warfarin 5 mg/d were collected and tabulated in accordance with sampling time. All study drugs were given with once-daily administration. Subjects were monitored for adverse reactions and their severity, outcomes, and relationship to study drug. This influences of warfarin on the PK properties of henagliflozin (Cmax,ss and AUCτ,ss), the effects of henagliflozin on the PK properties of warfarin (Cmax, AUC0-t, and AUC0-∞), and the influences of henagliflozin on the PD properties of warfarin (PTmax, PTAUC, INRmax, and INRAUC) were evaluated.

FINDINGS

The geometric mean ratios (GMRs; 90% CIs) of henagliflozin Cmax,ss and AUCτ,ss were 101.75% (96.11%-107.72%) and 102.21% (100.04%-104.42%), respectively. The GMRs (90% CIs) of S- and R-warfarin Cmax, AUC0-t, and AUC0-∞ were as follows: Cmax, 114.31% (106.30%-122.91%) and 115.09% (109.46%-121.01%), respectively; AUC0-t, 120.15% (116.71%-123.69%) and 119.01% (116.32%-121.76%); and AUC0-∞, 120.81% (117.17%-124.58%) and 121.94% (118.90%-125.05%). The GMRs (90% CIs) of warfarin PTmax and PTAUC were 92.73% (91.25%-94.22%) and 97.42% (96.61%-98.24%). The GMRs (90% CIs) of warfarin INRmax and INRAUC were 92.66% (91.17%-94.17%) and 97.36% (96.52%-98.21%). A total of 32 cases of mild adverse events were reported, and were recovered/resolved. There were no serious adverse events reported.

IMPLICATIONS

No significant clinically relevant effects on the PK/PD properties of henagliflozin or warfarin were found with coadministration of the two drugs in these healthy male Chinese subjects. Based on these findings, it is expected that henagliflozin and warfarin can be used in combination without dose adjustment. Chinadrugtrials.org.cn identifier: CTR20190240.

Platelet Glycoprotein-Ib (GPIb) May Serve as a Bridge between Type 2 Diabetes Mellitus (T2DM) and Atherosclerosis, Making It a Potential Target for Antiplatelet Agents in T2DM Patients

Type 2 diabetes mellitus (T2DM) is a persistent metabolic condition that contributes to the development of cardiovascular diseases. Numerous studies have provided evidence that individuals with T2DM are at a greater risk of developing cardiovascular diseases, typically two to four times more likely than those without T2DM, mainly due to an increased risk of atherosclerosis. The rupture of an atherosclerotic plaque leading to pathological thrombosis is commonly recognized as a significant factor in advancing cardiovascular diseases caused by TD2M, with platelets inducing the impact of plaque rupture in established atherosclerosis and predisposing to the primary expansion of atherosclerosis. Studies suggest that individuals with T2DM have platelets that display higher baseline activation and reactivity than those without the condition. The expression enhancement of several platelet receptors is known to regulate platelet activation signaling, including platelet glycoprotein-Ib (GPIb). Furthermore, the high expression of platelet GP1b has been reported to increase the risk of platelet adhesion, platelet-leucocyte interaction, and thrombo-inflammatory pathology. However, the study exploring the role of GP1b in promoting platelet activation-induced cardiovascular diseases in T2DM patients is still limited. Therefore, we summarize the important findings regarding pathophysiological continuity between T2DM, platelet GPIb, and atherosclerosis and highlight the potential therapy targeting GPIb as a novel antiplatelet agent for preventing further cardiovascular incidents in TD2M patients.

Structure-Activity Relationship Analysis of Rhosin, a RhoA GTPase Inhibitor, Reveals a New Class of Antiplatelet Agents

Current antiplatelet therapies have several clinical complications and are mostly irreversible in terms of suppressing platelet activity; hence, there is a need to develop improved therapeutic agents. Previous studies have implicated RhoA in platelet activation. Here, we further characterized the lead RhoA inhibitor, Rhosin/G04, in platelet function and present structure-activity relationship (SAR) analysis. A screening for Rhosin/G04 analogs in our chemical library by similarity and substructure searches revealed compounds that showed enhanced antiplatelet activity and suppressed RhoA activity and signaling. A screening for Rhosin/G04 analogs in our chemical library using similarity and substructure searches revealed compounds that showed enhanced antiplatelet activity and suppressed RhoA activity and signaling. SAR analysis revealed that the active compounds have a quinoline group optimally attached to the hydrazine at the 4-position and halogen substituents at the 7- or 8-position. Having indole, methylphenyl, or dichloro-phenyl substituents led to better potency. Rhosin/G04 contains a pair of enantiomers, and S-G04 is significantly more potent than R-G04 in inhibiting RhoA activation and platelet aggregation. Furthermore, the inhibitory effect is reversible, and S-G04 is capable of inhibiting diverse-agonist-stimulated platelet activation. This study identified a new generation of small-molecule RhoA inhibitors, including an enantiomer capable of broadly and reversibly modulating platelet activity.

Is Triglyceride-Glucose Index a Valuable Parameter in Peripheral Artery Disease?

Background The aim of this study was to investigate the relationship between the triglyceride-glucose (TyG) index and peripheral artery disease. Methodology This was a single-center, observational, retrospective study that included patients evaluated with color Doppler ultrasonography. A total of 440 individuals, 211 peripheral artery patients and 229 healthy controls, were included in the study. Results The TyG index levels were significantly higher in the peripheral artery disease group than in the control group (9.19 ± 0.57 vs. 8.80 ± 0.59; p < 0.001). The multivariate regression analysis conducted to determine the independent predictors of peripheral artery disease revealed that age (odds ratio (OR) = 1.111, 95% confidence interval (CI) = 1.083-1.139; p < 0.001), male gender (OR = 0.441, 95% CI = 0.249-0.782; p = 0.005), diabetes mellitus (OR = 1.925, 95% CI = 1.018-3.641; p = 0.044), hypertension (OR = 0.036, 95% CI = 0.285- 0.959; p = 0.036), coronary artery disease (OR = 2.540, 95% CI = 1.376-4.690; p = 0.003), white blood cell count (OR = 1.263, 95% CI = 1.029-1.550; p = 0.026), creatinine (OR = 0.975, 95% CI = 0.952-0.999; p = 0.041), and TyG index (OR = 1.111, 95% CI = 1.083-1.139; p < 0.001) were independent predictors of peripheral artery disease. The cut-off value of the TyG index in predicting peripheral artery disease was determined to be 9.06 with a sensitivity of 57.8% and a specificity of 70% (area under the curve = 0.689; 95% CI = 0.640-0.738; p < 0.001). Conclusions High TyG index values can be used as an independent predictor of peripheral artery disease.

The impact of SGLT2-inhibitor therapy on platelet function in type 2 diabetes mellitus

Aim: We consider mean platelet volume (MPV), an a pointer of platelet activity related to type 2 diabetes mellitus (T2DM) and vascular complications, in patients using Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i). Therefore, we aimed to evaluate the MPV change after SGLT2i use in diabetic patients. Materials and Methods: Hemogram parameters such as hemoglobin, hematocrit, and MPV in the 0th and 24th weeks of 102 patients with T2DM that received SGLT2i treatment added to their existing medications and of the control group in which participants are compatible in terms of age and gender factor were compared. Results: A significant increase was observed in the values of MPV and hemoglobin in the 0th and 24th weeks (9.3 (8.2-10.3) to 10.1 ± 1.3, p

Type 2 Diabetes Mellitus, Platelet Activation and Alzheimer's Disease: A Possible Connection

Type 2 diabetes mellitus DM (T2DM) is associated with a 70% increased risk for dementia, including Alzheimer's disease (AD). Insulin resistance has been proposed to play a pivotal role in both T2DM and AD and the concept of "brain insulin resistance" has been suggested as an interpretation to the growing literature regarding cognitive impairment and T2DM. Subjects with T2DM present an abnormal platelet reactivity that together with insulin resistance, hyperglycaemia and dyslipidaemia effect the vascular wall by a series of events including endothelial dysfunction, oxidative stress and low-grade inflammation. Activated platelets directly contribute to cerebral amyloid angiopathy (CAA) by promoting the formation of β-amyloid (Aβ) aggregates and that Aβ, in turn, activates platelets, creating a feed-forward loop suggesting the involvement of platelets in the AD pathogenesis. Moreover, islet amyloid polypeptide deposition, co-localized with Aβ deposits, is a common finding in the brain of patients with T2DM. These observations raise the intriguing prospect that traditional or novel antiplatelet therapeutic strategies may alleviate fibril formation and could be used in the prevention or treatment of AD subjects with diabetes.

Bias or biology? Importance of model interpretation in machine learning studies from electronic health records

Objective

The rate of diabetic complication progression varies across individuals and understanding factors that alter the rate of complication progression may uncover new clinical interventions for personalized diabetes management.

Materials and Methods

We explore how various machine learning (ML) models and types of electronic health records (EHRs) can predict fast versus slow onset of neuropathy, nephropathy, ocular disease, or cardiovascular disease using only patient data collected prior to diabetes diagnosis.

Results

We find that optimized random forest models performed best to accurately predict the diagnosis of a diabetic complication, with the most effective model distinguishing between fast versus slow nephropathy (AUROC = 0.75). Using all data sets combined allowed for the highest model predictive performance, and social history or laboratory alone were most predictive. SHapley Additive exPlanations (SHAP) model interpretation allowed for exploration of predictors of fast and slow complication diagnosis, including underlying biases present in the EHR. Patients in the fast group had more medical visits, incurring a potential informed decision bias.

Discussion

Our study is unique in the realm of ML studies as it leverages SHAP as a starting point to explore patient markers not routinely used in diabetes monitoring. A mix of both bias and biological processes is likely present in influencing a model's ability to distinguish between groups.

Conclusion

Overall, model interpretation is a critical step in evaluating validity of a user-intended endpoint for a model when using EHR data, and predictors affected by bias and those driven by biologic processes should be equally recognized.

The role of the platelet pool of Plasminogen Activator Inhibitor-1 in well-controlled type 2 diabetes patients

Background

The main inhibitor of the fibrinolytic system, Plasminogen Activator Inhibitor -1 (PAI-1), irreversibly binds tissue-type Plasminogen Activator (t-PA) and thereby inhibits the protective action of tPA against thrombus formation. Elevated levels of plasma PAI-1 are associated with an increased risk of cardiovascular events and are observed in subjects with type 2 diabetes (T2D) and obesity. Platelets contain the majority of PAI-1 present in blood and exhibit the ability to synthesis active PAI-1. Diabetic platelets are known to be hyper-reactive and larger in size; however, whether these features affect their contribution to the elevated levels of plasma PAI-1 in T2D is not established.

Objectives

To characterize the PAI-1 antigen content and the mRNA expression in platelets from T2D subjects compared to obese and lean control subjects, in order to elucidate the role of platelet PAI-1 in T2D.

Methods

Nine subjects with T2D and obesity were recruited from Primary Care Centers together with 15 healthy control subjects (8 lean subjects and 7 with obesity). PAI-1 antigen levels in plasma, serum and platelets were determined by ELISA, and PAI-1 mRNA expression was analyzed by qPCR.

Results

There was no significant difference in PAI-1 mRNA expression or PAI-1 antigen in platelets in T2D subject in comparison to obese and lean control subjects. An elevated level of plasma PAI-1 was seen in both T2D and obese subjects. PAI-1 gene expression was significantly higher in both obese groups compared to lean.

Conclusion

Similar levels of protein and mRNA expression of PAI-1 in platelets from T2D, obese and lean subjects indicate a limited role of platelets for the elevated plasma PAI-1 levels. However, an increased synthesis rate of mRNA transcripts in platelets from T2D and an increased release of PAI-1 could also result in similar mRNA and protein levels. Hence, synthesis and release rates of PAI-1 from platelets in T2D and obesity need to be investigated to further elucidate the role of platelets in obesity and T2D.

Relationship between the Soluble F11 Receptor and Annexin A5 in African Americans Patients with Type-2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is characterized by endothelial dysfunction, increased thrombogenicity, and inflammation. The soluble human F11 receptor (sF11R) and annexin A5 (ANXA5) play crucial roles in inflammatory thrombosis and atherosclerosis. We examined the relationship between circulating sF11R and ANXA5 and their impact on endothelial function. The study included 125 patients with T2DM. Plasma levels of sF11R and ANXA5 were quantified by ELISA. Microvascular function was assessed using the vascular reactivity index (VRI). Large artery stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Carotid intima-media thickness (CIMT) was assessed by B-mode ultrasound imaging. The mean age of patients in the study was 59.7 ± 7.8 years, 78% had hypertension, 76% had dyslipidemia, and 12% had CKD. sF11R correlated positively with ANXA5 levels (β = 0.250, p = 0.005), and correlated inversely with VRI and total nitic oxide (NO), (β = −0.201, p = 0.024; β = −0.357, p = 0.0001, respectively). Multivariate regression analysis revealed that sF11R was independently associated with ANXA5 in the total population and in patients with HbA1c > 6.5% (β = 0.366, p = 0.007; β = 0.425, p = 0.0001, respectively). sF11R and ANXA5 were not associated with vascular outcome, suggesting that they may not be reliable markers of vascular dysfunction in diabetes. The clinical significance of sF11R/ANXA5 association in diabetes warrants further investigation in a larger population.

The Role of Platelets in Diabetic Kidney Disease

Diabetic kidney disease (DKD) is among the most common microvascular complications in patients with diabetes, and it currently accounts for the majority of end-stage kidney disease cases worldwide. The pathogenesis of DKD is complex and multifactorial, including systemic and intra-renal inflammatory and coagulation processes. Activated platelets play a pivotal role in inflammation, coagulation, and fibrosis. Mounting evidence shows that platelets play a role in the pathogenesis and progression of DKD. The potentially beneficial effects of antiplatelet agents in preventing progression of DKD has been studied in animal models and clinical trials. This review summarizes the current knowledge on the role of platelets in DKD, including the potential therapeutic effects of antiplatelet therapies.

Peripheral Cytopenia and Its Associated Factors in Type 2 Diabetes Mellitus Patients, Northwest Ethiopia

Background

Hematological abnormalities are linked with diabetes mellitus (DM) and play a major role in diabetes-related micro- and macro-vascular complications. Therefore, this study aimed to investigate the magnitude of peripheral cytopenia and associated factors in type 2 diabetes (T2DM) patients.

Methods

A cross-sectional study was conducted from March to May 2021 at the University of Gondar Comprehensive Specialized Hospital. A total of 357 T2DM participants were selected using a simple random sampling technique. A total of 3 mL of venous blood samples were collected using the vacutainer method for the complete blood count (CBC). A univariate and multivariate regression analysis were used to investigate the association between dependent and independent variables. P-value ˂0.05 was considered statistically significant.

Results

The magnitude of cytopenia, bicytopenia, and pancytopenia were 21% (95% CI: 17.1, 25.53), 1.1% (95% CI: 0.44, 2.85), and 0.56% (95% CI: 0.01, 1.12), respectively. Furthermore, the magnitudes of anemia, leucopenia, and thrombocytopenia were 8.7% (95% CI: 6.18, 12.06), 10.9% (95% CI: 8.09, 14.59), and 5.3% (95% CI: 3.43, 8.16), respectively. Being male (AOR: 3.23; 95% CI: 1.43, 7.56), lack of exercise (AOR: 2.70; 95% CI: 1.137, 6.43), and never married (AOR: 3.90; 95% CI: 1.248, 12.18) were all associated with anemia.

Conclusion

This study showed that T2DM causes disturbances in the hematological parameters and leads to a mild level of cytopenia. It is, therefore, suggested that hematological abnormalities, especially cytopenia, should be monitored and controlled on a regular basis in T2DM patients for better prognosis and quality of life.

Mean platelet volume and glycaemic control in patients with new-onset Type 2 diabetes mellitus

Introduction:

Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with vascular complications that are attributable to dysregulated platelet reactivity as measured by mean platelet volume (MPV). This study aimed at determining a relationship between MPV and glycaemic control in new-onset T2DM.

Materials and methods:

This was a prospective study conducted on 236 new-onset T2DM patients divided in two groups as group A, glycosylated haemoglobin A1c (HbA1c < 7.9%; n = 70) and group B, HbA1c ⩾ 8% ( n = 107) who were followed up for 6 months for change in platelet and glycaemic parameters.

Results:

At 6-month follow-up, there was a significant decrease in HbA1c and MPV (group A (HbA1c: 7.40 ± 0.40 vs 7.03 ± 0.23%, p < 0.03; MPV: 9.65 fl ± 0.74 vs 9.46 fl ± 0.71, p < 0.001) and group B (HbA1c: 10.59 ± 1.89% vs 9.29 ± 1.50%, p < 0.001; MPV: 10.89 fL ± 1.29 vs. 10.23 fL ± 1.40, p< 0.001)). The percentage decline in HbA1c was more in group B (11.81 ± 5.87 vs 4.76 ± 4.58, p < 0.01). There was a positive correlation between ΔMPV and ΔHbA1c in group B; however, we did not observe significant correlation for group A.

Conclusion:

We interpret that in people with diabetes with baseline HbA1c ⩾ 8%, with improvement in glycaemic control, there is a significant decrease in MPV. We propose that a routine MPV testing can be used as a potential marker for glycaemic control in T2DM.

Vitamin D Supplementation Modulates Platelet-Mediated Inflammation in Subjects With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial

Background

Recently, our group identified increased platelet-mediated inflammation in type 2 diabetes (T2DM) patients, and it is a well-established risk factor for diabetes complications, particularly for the development of cardiovascular diseases (CVD). Furthermore, vitamin D is reported to play an important role in the modulation of platelet hyperactivity and immune function, although the effect of vitamin D on platelet-mediated inflammation is not well studied. Hence, we aimed to investigate the effect of vitamin D supplementation on platelet-mediated inflammation in T2DM patients.

Methods

After screening a total of 201 subjects, our randomized, double-blind, placebo-controlled trial included 59 vitamin-D-deficient T2DM subjects, and the participants were randomly assigned to placebo (n = 29) or vitamin D3 (n = 30) for 6 months. Serum vitamin D metabolite levels, immunome profiling, platelet activation, and platelet-immune cell aggregate formation were measured at baseline and at the end of the study. Similarly, the serum levels of inflammatory cytokines/chemokines were assessed by a multiplex assay.

Results

Six months of vitamin D supplementation increases the serum vitamin D3 and total 25(OH)D levels from the baseline (p < 0.05). Vitamin D supplementation does not improve glycemic control, and no significant difference was observed in immune cells. However, platelet activation and platelet immune cell aggregates were altered after the vitamin D intervention (p < 0.05). Moreover, vitamin D reduces the serum levels of IL-18, TNF-α, IFN-γ, CXCL-10, CXCL-12, CCL-2, CCL-5, CCL-11, and PF-4 levels compared to the baseline levels (p < 0.05). Our ex vivo experiment confirms that a sufficient circulating level of vitamin D reduces platelet activation and platelet intracellular reactive oxygen species.

Conclusion

Our study results provide evidence that vitamin D supportive therapy may help to reduce or prevent the disease progression and cardiovascular risk in T2DM patients by suppressing oxidative stress and platelet-mediated inflammation.

Clinical Trial Registration

Clinical Trial Registry of India: CTRI/2019/01/016921.

An Insight into Recent Advances on Platelet Function in Health and Disease

Platelets play a variety of roles in vascular biology and are best recognized as primary hemostasis and thrombosis mediators. Platelets have a large number of receptors and secretory molecules that are required for platelet functionality. Upon activation, platelets release multiple substances that have the ability to influence both physiological and pathophysiological processes including inflammation, tissue regeneration and repair, cancer progression, and spreading. The involvement of platelets in the progression and seriousness of a variety of disorders other than thrombosis is still being discovered, especially in the areas of inflammation and the immunological response. This review represents an integrated summary of recent advances on the function of platelets in pathophysiology that connects hemostasis, inflammation, and immunological response in health and disease and suggests that antiplatelet treatment might be used for more than only thrombosis.

Proteome and functional decline as platelets age in the circulation

BACKGROUND

Platelets circulate in the blood of healthy individuals for approximately 7-10 days regulated by finely balanced processes of production and destruction. As platelets are anucleate we reasoned that their protein composition would change as they age and that this change would be linked to alterations in structure and function.

OBJECTIVE

To isolate platelets of different ages from healthy individuals to test the hypothesis that changes in protein content cause alterations in platelet structure and function.

METHODS

Platelets were separated according to thiazole orange fluorescence intensity as a surrogate indicator of mRNA content and so a marker of platelet age and then subjected to proteomics, imaging, and functional assays to produce an in-depth analysis of platelet composition and function.

RESULTS

Total protein content was 45 ± 5% lower in old platelets compared to young platelets. Predictive proteomic pathway analysis identified associations with 28 biological processes, notably higher hemostasis in young platelets whilst apoptosis and senescence were higher in old platelets. Further studies confirmed platelet ageing was linked to a decrease in cytoskeletal protein and associated capability to spread and adhere, a reduction in mitochondria number, and lower calcium dynamics and granule secretion.

CONCLUSIONS

Our findings demonstrate changes in protein content are linked to alterations in function as platelets age. This work delineates physical and functional changes in platelets as they age and serves as a base to examine differences associated with altered mean age of platelet populations in conditions such as immune thrombocytopenia and diabetes.

Effect of irisin on metabolic and platelet functions in type 2 diabetic rats: role of soluble receptor of advanced glycation end products (sRAGE)

Background

Irisin is an adipomyokine with a promising potential for the treatment of metabolic disturbances and endothelial dysfunction. This study aimed to explore the effect of irisin on metabolic and platelet functions, and to explore the possible involvement of soluble receptor of advanced glycation end product (sRAGE) in the type 2 diabetes mellitus (T2DM) rat model. Thirty-three adult male albino rats were divided into three groups: normal control, vehicle-treated T2DM group, and irisin-treated T2DM. At the end of the study period, metabolic parameters, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and serum sRAGE were determined.

Results

Irisin significantly improved platelet function and metabolic derangements induced by T2DM and significantly increased sRAGE. sRAGE was significantly negatively associated with platelet function parameters and some glucometabolic parameters. Additionally, mean platelet volume showed a significant predictive value for the change in serum sRAGE.

Conclusions

Irisin could have a protective role against diabetes-induced platelet dysfunction by increasing sRAGE levels, indicating the potential beneficial effects of sRAGE in the type 2 diabetic rat model.

Impact of Pancreatic β-Cell Function on Clopidogrel Responsiveness and Outcomes in Chinese Nondiabetic Patients Undergoing Elective Percutaneous Coronary Intervention

PURPOSE

Insulin resistance and β-cell dysfunction are fundamental defects contributing to type 2 diabetes development. Prior studies indicated that insulin resistance may be correlated with low responsiveness to clopidogrel. This study aimed to investigate the effects of β-cell function on clopidogrel-induced platelet P2Y12 inhibition and the clinical outcomes of nondiabetic patients undergoing elective percutaneous coronary intervention (PCI).

METHODS

Patients scheduled to undergo elective PCI and receive clopidogrel in addition to aspirin were recruited for this study. Homeostatic model assessment 2 of β-cell function (HOMA2-β%) was used to classify participants into quartiles. Thromboelastography (TEG) was used to calculate the quantitative platelet inhibition rate to assess clopidogrel-induced antiplatelet reactivity. The clinical outcome was major adverse cardiovascular and cerebrovascular events (MACCEs).

RESULTS

Of the 784 participants evaluated, 21.3% of them (169 of 784) had low responsiveness to clopidogrel. According to multivariate linear regression analysis, the first quartile of HOMA2-β% (19.9-78.1), indicating greater β-cell dysfunction, was independently associated with low responsiveness to clopidogrel compared with the fourth quartile (126.8-326.2) after adjustment for potential covariates [odds ratio 2.140, 95% confidence interval (CI) (1.336 to 3.570), P = 0.038]. In addition, at one year, the first quartile of HOMA2-β% was associated with an increased risk of 1-year MACCE occurrence compared with the fourth quartile [adjusted hazard ratio 4.989, 95% CI (1.571 to 15.845), P = 0.006].

CONCLUSION

Increased β-cell dysfunction, indicated by a low HOMA2-β%, was associated with low responsiveness to clopidogrel and an increased risk of one-year MACCEs in nondiabetic patients undergoing elective PCI.

Intravital assessment of precapillary pulmonary arterioles of type 1 diabetic mice shows oxidative damage and increased tone in response to NOS inhibition

Microvascular dilation, important for peripheral tissue glucose distribution, also modulates alveolar perfusion and is inhibited by loss of bioavailable nitric oxide (NO) in diabetes mellitus (DM). We hypothesized that DM-induced oxidative stress decreases bioavailable NO and pulmonary precapillary arteriolar diameter, causing endothelial injury. We examined subpleural pulmonary arterioles after acute NO synthase (NOS) inhibition with NG-nitro-l-arginine methyl ester (l-NAME) in streptozotocin (STZ)- and saline (CTRL)-treated C57BL/6J mice. Microvascular changes were assessed by intravital microscopy in the right lung of anesthetized mice with open chest and ventilated lungs. Arteriolar tone in pulmonary arterioles (27.2-48.7 µm diameter) increased in CTRL mice (18.0 ± 11% constriction, P = 0.034, n = 5) but decreased in STZ mice (13.6 ± 7.5% dilation, P = 0.009, n = 5) after l-NAME. Lung tissue dihydroethidium (DHE) fluorescence (superoxide), inducible NOS expression, and protein nitrosylation (3-nitrotyrosine) increased in STZ mice and correlated with increased glucose levels (103.8 ± 8.8 mg/dL). Fluorescently labeled fibrinogen administration and fibrinogen immunostaining showed fibrinogen adhesion, indicating endothelial injury in STZ mice. In CTRL mice, vasoconstriction to l-NAME was likely due to the loss of bioavailable NO. Vasodilation in STZ mice may be due to decreased formation of a vasoconstrictor or emergence of a vasodilator. These findings provide novel evidence that DM targets the pulmonary microcirculation and that decreased NO bioavailability and increased precapillary arteriolar tone could potentially lead to ventilation-perfusion abnormalities, exacerbating systemic DM complications.NEW & NOTEWORTHY Diabetes pulmonary and microvascular consequences are well recognized but have not been characterized. We assessed lung microvascular changes in a live anesthetized mouse model of type 1 diabetes, using a novel intravital microscopy technique. Our results show new evidence that a diabetes-induced decrease in lung nitric oxide bioavailability underlies oxidative damage, enhanced platelet activation, and endothelial injury causing pulmonary microvascular dysfunction and altered vasoreactivity. These findings could provide novel strategies to prevent or reverse diabetes systemic consequences.

Mean Platelet Volume is Associated with Pancreatic β-Cell Dysfunction in Nondiabetic Patients with Coronary Artery Disease

Purpose

Mean platelet volume (MPV) is an indicator of platelet activation. Pancreatic β-cell dysfunction is one of the fundamental defects contributing to the development of type 2 diabetes. The aim of this study was to assess the relationship between β-cell dysfunction and MPV in nondiabetic patients with coronary artery disease (CAD).

Patients and Methods

A total of 1143 consecutive nondiabetic patients (874 males and 269 females; mean age 60.0±10.3 years) with CAD were recruited for this analysis. All patients were individuals who underwent coronary angiography with a suspicion of CAD. Homeostatic model assessment 2 (HOMA2) of β-cell function (HOMA2-β%) was performed, and β-cell dysfunction was defined by a HOMA2-β% in the lowest quartile.

Results

MPV was significantly higher in CAD patients with β-cell dysfunction than in controls [(10.6±1.0)fl vs (10.0±1.0)fl, P=0.011]. According to the multiple regression model, pancreatic β-cell dysfunction was independently associated with MPV (β=0.210, P=0.006) and age (β=0.008, P=0.028).

Conclusion

MPV was significantly elevated in nondiabetic CAD patients with β-cell dysfunction compared to patients with normal β-cell function.

Platelet Mediated Inflammation in Coronary Artery Disease with Type 2 Diabetes Patients

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a well-established risk factor for the development of atherosclerotic coronary artery disease. Platelet hyperactivity and inflammation are associated with the development of coronary artery disease (CAD) in T2DM patients. We investigated the status of immune cells, platelet activation, and platelet-immune cell interactions in T2DM_CAD patients.

METHODOLOGY

The study population consisted of four groups of subjects, healthy control (CT, n = 20), T2DM (n = 44), CAD (n = 20) and T2DM_CAD (n = 38). Platelet activation, immunome profiling and platelet-immune cell interactions were analysed by flow cytometry. The circulatory levels of inflammatory cytokines/chemokines were assessed using multiplex assay.

RESULTS

Increased platelet activation and increased platelet-immune cell aggregate formation were observed in T2DM and T2DM_CAD groups compared to the control and CAD groups (p < 0.05). Our immunome profile analysis revealed, altered monocyte subpopulations and dendritic cell populations in T2DM, CAD and T2DM_CAD groups compared to the control group (p < 0.05). Furthermore, significantly increased IL-1β, IL-2, IL-4, IL-6, IL-8, IL12p70, IL-13 IL-18, CCL2, and decreased CXCL1, CCL5 levels were observed in T2DM_CAD group compared to the control group. Our ex-vivo study increased platelet-monocyte aggregate formation was observed upon D-glucose exposure in a time and concentration dependent manner.

CONCLUSION

Our data suggests that T2DM, CAD and T2DM_CAD are associated with altered immune cell populations. Furthermore, it has been confirmed that hyperglycemia induces platelet activation and forms platelet-immune cell aggregation which may lead to the release of inflammatory cytokines and chemokines and contribute to the complexity of CAD and type 2 diabetes.

Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes

BACKGROUND

Risk stratification of patients with prediabetes is an unmet clinical need. Here, we examine the utility of subclinical myocardial necrosis assessed by high-sensitivity cardiac troponin T (hs-cTnT) in predicting health outcomes in stable subjects with prediabetes.

METHODS

hs-cTnT was analyzed by a high-sensitivity assay (Roche 5th generation) in 2631 stable subjects with prediabetes (HbA1c 5.7-6.4% or fasting glucose 100-125 mg/dL without previous diagnosis of diabetes or glucose-lowering therapy) who underwent elective coronary angiography for cardiac evaluation, and followed for major adverse cardiac events (MACE; death, myocardial infarction, stroke) over 3 years and all-cause mortality over 5 years.

RESULTS

In our study cohort, hs-cTnT was highly prevalent with a median level of 13 ng/L (interquartile range 8.2-21.6 ng/L). Hs-cTnT was independently associated with incident MACE at 3 years (Q4 vs. Q1 adjusted hazard ratio (HR) 2.42 [95% CI 1.69-3.46], P < 0.001) and 5-year mortality (adjusted HR 3.8 [95% CI 2.55-5.67], P < 0.001). This association remained significant in all subsets after adjustment for traditional risk factors and multiple factors known to increase hs-cTnT levels. Moreover, hs-cTnT independently predicted event risk in primary prevention subjects (n = 557, HR 5.46 [95% CI 1.50-19.89), p < 0.01) for MACE; HR 9.53 [95% CI 2.08-43.73] for all-cause mortality) and secondary prevention subjects (n = 2074, HR 1.86 [95% CI 1.31-2.66], P < 0.001 for MACE; and 2.7 [95% CI 1.79-4.08), P < 0.001 for all-cause mortality).

CONCLUSIONS

In stable prediabetic subjects, the presence of subclinical myocardial necrosis as detected by hs-cTnT portends heightened long-term adverse cardiovascular event risk. Hs-cTnT levels may help to stratify risk and improve clinical decision making in patients with prediabetes. Trial registration ClinicalTrials.gov Identifier: NCT00590200.

Long-term aerobic exercise training in type two diabetic patients alters the expression of miRNA-223 and its corresponding target, the P2RY12 receptor, attenuating platelet function

BACKGROUND

Type two diabetes mellitus (T2DM) patients are prone to develop atherothrombotic events due to platelet hyper-reactivity stemming from platelet miRNA-223 down-regulation and over-expression of its corresponding target, P2RY12.

OBJECTIVE

The study sought to determine the effects of long-term aerobic training on the expression levels of miRNA-223 and P2RY12 mRNA, and platelet function in T2DM patients.

METHODS

Twenty-four patients with T2DM (age, 60.0±2.8 yrs.) were selected and randomly divided into two groups: aerobic exercise training (AET, n = 12) and control (CON, n = 12). The AET protocol was performed with moderate intensity for 12 weeks, while patients in the CON group followed their usual routine. Weight, body mass index (BMI), peak oxygen consumption (VO2peak), lipid profile, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), platelet miRNA-223 and P2RY12 expression were measured before and after the period.

RESULTS

There was a significant improvement in body weight, BMI, VO2peak, FBG, HbA1c, and HOMA-IR, after 12 weeks of AET (P <  0.01). Platelet aggregation decreased significantly after 12 weeks in the AET group compared with the CON (P <  0.001) group. Platelets' miRNA-223 and P2RY12 were significantly up- and down-regulated after AET in comparison with the CON group (P <  0.05), respectively. Moreover, the relative expression of miRNA-223 and P2RY12 significantly correlated with FBG changes following the intervention.

CONCLUSIONS

It can be concluded that long-term moderate-intensity aerobic training might be effective for reducing the occurrence of atherothrombotic events leading to premature death in T2DM patients through the modulation of miRNA-223, P2RY12 receptor expression, and platelet function.

Purinergic interplay between erythrocytes and platelets in diabetes-associated vascular dysfunction

Cardiovascular complications in diabetes are the leading causes for high morbidity and mortality. It has been shown that alteration of purinergic signaling contributes to diabetes-associated cardiovascular complications. Red blood cells (RBCs) and platelets play a fundamental role in regulation of oxygen transport and hemostasis, respectively. Of note, these cells undergo purinergic dysfunction in diabetes. Recent studies have established a novel function of RBCs as disease mediators for the development of endothelial dysfunction in type 2 diabetes (T2D). RBC-released ATP is defective in T2D, which has implication for induction of vascular dysfunction by dysregulating purinergic signaling. Platelets are hyperactive in diabetes. ADP-mediated P2Y₁ and P2Y₁₂ receptor activation contributes to platelet aggregation and targeting P2Y receptors particularly P2Y₁₂ receptor in platelets is effective for the treatment of cardiovascular events. In contrast to other P2Y₁₂ receptor antagonists, platelet-targeting drug ticagrelor has potential to initiate purinergic signaling in RBCs for the beneficial cardiovascular outcomes. It is increasingly clear that altered vascular purinergic signaling mediated by various nucleotides and nucleoside contributes to diabetes-associated vascular dysfunction. However, the contribution of complex purinergic networks between RBCs and platelets to the vascular dysfunction in diabetes remains unclear. This study discusses the possible interplay of RBCs and platelets via the purinergic network for diabetes-associated vascular dysfunction.

Inflammation in Metabolic and Cardiovascular Disorders-Role of Oxidative Stress

Cardiovascular diseases (CVD) constitute the main cause of death worldwide. Both inflammation and oxidative stress have been reported to be involved in the progress of CVD. It is well known that generation of oxidative stress during the course of CVD is involved in tissue damage and inflammation, causing deleterious effects such as hypertension, dysfunctional metabolism, endothelial dysfunction, stroke, and myocardial infarction. Remarkably, natural antioxidant strategies have been increasingly discovered and are subject to current scientific investigations. Here, we addressed the activation of immune cells in the context of ROS production, as well as how their interaction with other cellular players and further (immune) mediators contribute to metabolic and cardiovascular disorders. We also highlight how a dysregulated complement system contributes to immune imbalance and tissue damage in the context of increases oxidative stress. Additionally, modulation of hypothalamic oxidative stress is discussed, which may offer novel treatment strategies for type-2 diabetes and obesity. Together, we provide new perspectives on therapy strategies for CVD caused by oxidative stress, with a focus on oxidative stress.

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.

White blood cells and platelet profiles of diabetic patients at University of Gondar specialized referral hospital: A comparative cross-sectional study

BACKGROUND

Altered level of many hematological parameters such as white blood cells (WBC) and platelet function has been observed in diabetes mellitus (DM) patients. Therefore, this study aimed to determine the WBC and platelet profiles and their association with anthropometric measurement and blood pressure in DM patients and healthy controls.

METHOD

A comparative cross-sectional study was conducted on a total of 246 participants at the University of Gondar Specialized Referral Hospital. Venous blood with K₂ EDTA anticoagulant was drawn and analyzed by using Sysmex KX21N hematology analyzers for WBC and platelet parameters. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results were presented as frequency and mean ± standard deviation (SD). The independent sample t test was used to compare quantitative variables between DM and control groups. The bivariate (spearman's rank) correlation was used to analyze continuous variables. A p-value ˂ 0.05 was considered as statistically significant.

RESULTS

The mean platelet count was significantly higher among diabetics (252.77 ± 77.7) compared to non-diabetic controls (208.22 ± 68), p < 0.001. Similarly, the total WBC count was higher among DM patients (6.95 ± 2.23) than in the controls (6.15 ± 1.95), p = 0.04. A significant negative correlation was also found between neutrophil and duration of illness in DM patients. Besides, there is a significant positive correlation between WBC and lymphocyte number with systolic blood pressure (SBP) in DM patients.

CONCLUSION

Platelet and WBC count were significantly higher in DM patients than in the controls. Therefore, routine screening and profile checking of those abnormal indices is recommended to minimize DM-related complications.