Response: clinical marker of platelet hyperreactivity in diabetes mellitus (diabetes metab j 2013;37:423-8)

The unique association between the level of plateletcrit and the prevalence of diabetic kidney disease: a cross-sectional study

Objective

The activation of platelets in individuals with type 2 diabetes mellitus (T2DM) triggers inflammation and hemodynamic abnormalities, contributing to the development of diabetic kidney disease (DKD). Despite this, research into the relationship between plateletcrit (PCT) levels and DKD is sparse, with inconsistent conclusions drawn regarding the connection between various platelet parameters and DKD. This highlights the necessity for comprehensive, large-scale population studies. Therefore, our objective is to explore the association between PCT levels and various platelet parameters in relation to DKD.

Methods

In this cross-sectional study, hematological parameter data were collected from a cohort of 4,302 hospitalized Chinese patients. We analyzed the relationships between PCT, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), and DKD, along with the urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR). Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic potential of these parameters.

Results

DKD patients exhibited significantly higher PCT levels compared to those without DKD. Multivariate regression analysis identified elevated PCT and PLT levels as potential independent risk factors for both DKD and UACR, while lower MPV levels might serve as independent protective factors for eGFR. The areas under the ROC curve for PCT in relation to DKD and UACR (≥30 mg/g) were 0.523 and 0.526, respectively. The area under the ROC curve for PLT in relation to UACR (≥30 mg/g) was 0.523.

Conclusion

PCT demonstrates a weak diagnostic value for T2DM patients at risk of developing DKD and experiencing proteinuria, and PLT shows a similarly modest diagnostic utility for detecting proteinuria. These insights contribute to a deeper understanding of the complex dynamics involved in DKD. Additionally, incorporating these markers into routine clinical assessments could enhance risk stratification, facilitating early interventions and personalized management strategies.

Impact of Uncontrolled Diabetes Mellitus on Blood Cells Indices and Plasma Components in Patients Without Nephropathy

<b>Background and Objective:</b> Diabetes mellitus (DM) the most prevalent consequences are diabetic retinopathy, neuropathy, cardiovascular illnesses, erectile dysfunctions, stroke and cardiovascular difficulties. The main goal of this study was to evaluate the impact of uncontrolled diabetes mellitus on blood cells' indices and plasma components. <b>Materials and Methods:</b> This is a prospective cross-sectional study. The research was carried out at the King Fahad Medical Center in Riyadh, in duration from February, 2023 to May, 2023, in the interest of healthcare consumers attending the hematology laboratory for routine investigations. Sixty samples were collected and complete blood count, lipid profile, HbA1c and blood glucose for blood samples. <b>Results:</b> In this study, females accounted for 53.3% of the participants, while males accounted for 46.7%. In terms of age distribution, more than 55 years old accounted for 50% of the study's participants. A significant correlation has been found between HbA1c and red blood cell Mean Cell Volume (MCV) and there was a significant association between the high level of HbA1c and the red blood count. However, there was no significant correlation between plasma components and HbA1c. <b>Conclusion:</b> There is a remarkable effect of uncontrolled diabetes mellitus and RBCs count and erythrocyte MCV.

Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai

AIM

To investigate the prevalence of diabetic retinopathy (DR) in residents of Shanghai and analyze the risk factors of DR.

METHODS

This study involved 7233 patients with diabetes in 2016. The demographic data of the participants were collected using a questionnaire survey. Physical examination, laboratory tests, and ophthalmological examinations were conducted. Two professional ophthalmologists diagnosed and graded DR by fundus examination and then combined the results with fundus images. The unconditional multivariate Logistic regression analysis was used to determine the risk factors.

RESULTS

In total, 6978 patients with type 2 diabetes in Shanghai with a mean age of 68.33±8.40y were recruited, including 2975 males (42.6%) and 4003 females (57.4%). Overall, 1184 patients were diagnosed with DR, with a prevalence rate of 16.97%. Regression analysis showed that duration of diabetes (OR 1.061, 95%CI 1.049-1.073), high systolic blood pressure (SBP; OR 1.071, 95%CI 1.037-1.106), increased glycosylated hemoglobin level (OR 1.234, 95%CI 1.162-1.311), high blood glucose level (OR 1.061, 95%CI 1.023-1.099), increased neutrophil-to-lymphocyte ratio (NLR; OR 1.132, 95%CI 1.053-1.217) and mean platelet volume (MPV; OR 1.077, 95%CI 1.016-1.142) were risk factors of DR. Conversely, hematocrit (HCT; OR 0.971, 95%CI 0.954-0.988) and mean corpuscular volume (MCV; OR 0.980, 95%CI 0.965-0.994) were protective factors.

CONCLUSION

The prevalence rate of DR in Shanghai is 16.97%. The duration of diabetes, high SBP, increased glycosylated hemoglobin, NLR, and MPV were determined as risk factors of DR.

Effects of statin therapy on mean platelet volume in patients with risk of cardiovascular diseases: a systematic review and meta-analysis

Many studies have demonstrated the effects of statin therapy on platelet, but it is controversial that whether statin could reduce mean platelet volume (MPV) in patients with the risk of cardiovascular diseases. To further improve the clinical significance of MPV in those patients and explore new function of statin, we conducted this research. Relevant studies were selected by searching electronic databases (PubMed, Embase and Cochrane Library) and reference lists of related articles by hand. Two reviewers independently assessed eligibility and quality of the studies. Eventually, we included ten studies, a total of 1189 patients with the risk of cardiovascular diseases. Consolidating relevant data and comparing the changes of MPV before and after statin treatment, we found that statin could decrease MPV [standard mean difference (SMD) = −0.47 (−0.71–0.23)], which was statistically significant (P=0.0001). Subgroup analysis suggested that when ≥55 years, this decrease did not occur [SMD = −0.06 (−0.18, 0.06)]. Drug type, sample size, ethnicity, mean age and quality of included article were sources of heterogeneity. Therefore, statin therapy could reduce MPV significantly and exhibited antiplatelet activity, which is of great importance in clarifying the clinical significance of MPV in cardiovascular events and the prevention of cardiovascular events.

The relationship between mean platelet volume and diabetic retinopathy: a systematic review and meta-analysis

BACKGROUND

Diabetic retinopathy (DR) is one of the most common diseases causing blindness in the world, and most patients are already in advanced stage. Recent years, many studies reported mean platelet volume (MPV) may be associated with development of DR, but there was no consistent conclusion reached.

METHODS

Literature was retrieved by formally searching PubMed, Embase, Cochrane library and Scopus and by hand searching of reference lists of related articles. Finally, a total of 14 literatures included, and Review manager 5.3 and STATA 14.0 statistical software were utilized for processing.

RESULTS

Meta-analysis showed that MPV values in DR were significantly higher than health controls [SMD (95% CI) = 0.92 (0.60-1.24)] and type 2 diabetes mellitus without diabetic retinopathy (T2DM without DR) [SMD (95% CI) = 0.36 (0.19-0.53)]. Subgroup analysis indicated that MPV level in proliferative diabetic retinopathy (PDR) patients was higher than T2DM without DR patients [SMD (95% CI) = 0.48 (0.28, 0.68)], but this difference didn't appear in non-proliferative diabetic retinopathy (NPDR).

CONCLUSIONS

The study demonstrated that increased MPV level was significant associated with the development of DR, and it might reflect the severity of DR, which could be provided to monitor development and progression of DR clinically.

Platelets volume indexes and cardiovascular risk factors

Obesity, diabetes and hypertension are risk factors for cardiovascular diseases (CVD) because they promote a state of hypercoagulability. It is known that platelets play an important role in the development of atherosclerosis. Recent studies have evaluated platelet volume indexes (PVIs) in individuals with risk factors for CVD to better understand the platelet mechanisms involved in their development. The IVPs indirectly estimate platelet function and are easily obtained from automated hematology analyzers, which provide platelet counts, mean platelet volume (MPV), platelet distribution width (PDW) and the platelet-large cell ratio (P-LCR). The present study aims to review literature studies that investigated the association between PVIs and obesity, diabetes, and arterial hypertension, in order to evaluate its use as a potential subclinical marker of CVD. Studies have shown promising results for MPV, an index that allows for early detection of platelet activation and may be useful in identifying patients before the onset of CVD development so that preventive strategies can be implemented. The PDW, although evaluated by a smaller number of studies, also showed promising results. However, there is still a long way to go in order for the MPV and PDW to be used in clinical practice, since there is still a need for more epidemiological evidence, establishing reference values, and standardizing the way results are presented.

Association of hematological indicies with diabetes, impaired glucose regulation and microvascular complications of diabetes

In recent years, there has been renewed interest in hematological parameters as predictors of endothelial dysfunction and inflammation. The aim of our study is to evaluate the relationship between HbA1c and hematological indices, and to evaluate the relationship between these parameters and microvascular complications of diabetes. Three hundred and seven diabetic patients (124 male, 183 female; mean age 50.8±8.5), and 187 controls (76 male, 111 female; mean age 51.1±10.1) were included in the study. In the diabetic group, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), white blood cell count (WBC), platelet count, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) were significantly higher than the control group (P<0.05). Diabetic patients were divided into two group according to their HbA1c levels (Group 1; HbA1c <7 (n=82) and group 2; HbA1c ≥7 (n=225)). Mean platelet volume, PCT and PDW levels were significantly increased in group 2. Mean platelet volume was significantly increased in diabetic patients with retinopathy compared to those without retinopathy (P=0.006). The neutrophil to lymphocyte ratio and PLR levels were significantly higher in patients with nephropathy (P=0.004, P=0.004 respectively). There was statistically significant difference of lymphocyte count between patients with and without neuropathy. In correlation analysis, positive correlation between HbA1c and PCT (rs=0.192, P<0.001), HbA1c and PDW (rs=0.305, P<0.001), HbA1c and MPV (rs=0.352, P<0.001) were determined. In binary logistic regression analysis; WBC, PDW and PLR levels were found to be independently associated with diagnosis of diabetes while WBC, MPV, PLR and NLR levels were found to be independently associated with impaired glucose regulation. This study demonstrates that altered hematological indices are closely associated with HbA1c levels in individuals with and without diabetes and some of these parameters are associated with diabetic microvascular complications. These associations may be explained by connection between these easy accessible and inexpensive hematological indices and inflammation, tendency to coagulation and thrombosis in patients with diabetes.