Abstract

Background: This is an observational analytical case control study that had been conducted among diabetic patients in Khartoum State, during the period from December to February 2016 - 2017, to compare platelets parameters and D-dimer level between diabetic patients attending Diabetic and Endocrine Hospital, Soba University Hospital and non-diabetic controls. 80 blood samples were collected 40 samples from diabetic patients and 40 samples from non-diabetic controls.

Objectives: To evaluate platelet parameters and D-Dimer level in long standing Diabetes mellitus type 2 in Sudanese patients.

Method: After obtaining informed consent from each patient and non-diabetic control, 4 ml of venous blood were collected and divided into two parts: 2.5 ml transferred into K₂EDTA container for complete blood count, and 2.5 ml transferred into Tri Sodium Citrate container (9 volumes of blood is added to 1 volume of a 32 g/1 solution of TSC anticoagulant) and separated by centrifugation at 3000 rpm for 15 minutes, to obtain platelet poor plasma for measurement of D-Dimer level. The following tests were performed (platelets count, MPV, PDW, P-LCR and D-Dimer level) in both groups (case and control).

Result: Platelets count in both case and control was statistically insignificant (p = 0.392), while MPV (P = 0.034), PDW (p = 0.020), P-CLR (p = 0.012), and D-Dimer. Level (p = 0.015) were statistically significantly increased in patients compared to controls. There were no statistically significant differences in all measured parameters between gender, age and duration groups except platelets count which was significantly increased in patients under 50 years old. P-value < 0.05 was considered significant throughout the study.

Conclusion: Our study identified the altered platelets morphology and increased D-Dimer level among the long standing DM type 2 which are indicators of thrombotic state in diabetes mellitus. Based on these results we recommend the platelets indices and D-dimer level to the spectrum of thrombophilia which will be carried on long standing diabetes mellitus type 2 patients.

Keywords: Platelets; D-Dimer; Diabetes Mellitus

References

1. American Diabetes Association. “Diagnosis and classification of diabetes mellitus”. Diabetes Care 37.1 (2014): S81-90.
2. American Diabetes Association. “Diagnosis and classification of diabetes mellitus”. Diabetes Care 33.1 (2010): S62-S69.
3. Murphy D. “Acute complications of diabetes mellitus”. In Nurse practitioner forum 9.2 (1998): 69-73.
4. Kikkawa R. “Chronic complications in diabetes mellitus”. British Journal of Nutrition 84.2 (2000): S183-185.
5. World Health Organization. Global report on diabetes. World Health Organization (2016).
6. http://www.idf.org./membership/mena/sudan www.idf.org.
7. Hoffbrand AV., et al. “Essential haematology”. 4th edition. London: Black well (2001): 236-247.
8. Anna L., et al. “Hemostatic changes in patients with type 2 diabetes mellitus”. Revista Brasileira De Hematologica E Hemotepria 32.6 (2010): 482-488.
9. Dhara Kanani., et al. “Association of D-Dimer in type 2 diabetes mellitus”. International Journal of Advanced Research 5.2 (2017):2320-5407.
10. Frank F., et al. “Clinical haematology Medical Practice. 5th edition. Melbourne London. Edinburgh”. Berline”. Black Well science 24-25 (1989): 407.
11. Mustard JF and Packham MA. Platelets and diabetes mellitus.
12. Beckman JA., et al. “Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II”. European Heart Journal 26 (2013): 142.
13. Corcoran G and Marchant KK. “Chasing after the causes of platelet disorder”. Archives of Pathology and Laboratory Medicine 126 (2002): 133-146.
14. Greisenegger S., et al. Is Elevated Mean Platelet Volume Associated with a Worse Outcome in patients with Acute Ischemic Cerebrovascular Events Stroke 35 (2004): 1688.
15. Tavil Y., et al. “Mean platelet volume in patients with metabolic syndrome and its relationship with coronary artery disease”. Science Direct 120 (2007): 245-250.
16. Lewis S.M., et al. “Dacie and Lewies Practical Haematology”. 9th, edition, London, Edinpurgh, New York, Philadelphia, ST Louis”. Tornoto, Churchill Living Stone (2001):16.
17. Tschope D., et al. “Increase in the cystosolic concentration of calcium in platelets of diabetic type II”. Thrombosis Research 62 (1991): 421-428.
18. Khandekar MM., et al. “Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario”. Journal of Clinical Pathology 59.2 (2006):146-149.
19. Ntaios G., et al. “Increased values of mean platelet volume and platelet size deviation width may provide a safe positive diagnosis of idiopathic thrombocytopenic purpura”. Actahaematologica 119.3 (2008): 173-177.
20. Adam SS., et al. “D-dimer antigen: current concepts and future prospects”. Blood 113.13 (2009): 2878-2887.
21. Hekimsoy Z., et al. “Mean platelet volume in type 2 diabetic patients”. Journal of Diabetes and its Complications 18.3 (2004): 173-176.
22. Kodiatte TA., et al. “Mean platelet volume in type 2 diabetes mellitus”. Journal of Laboratory Physician 4.1 (2012): 5.
23. Ulutas KT., et al. “Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: a marker for atherosclerosis”. International Journal of Clinical and Experimental Medicine 7.4 (2014): 955-961.
24. OA Widaa. “Mean platelet volume in type 2 diabetes mellitus. University of Khartoum”. Department of Haematology and Immunohematology (2007).
25. Papanas M., et al. “Mean platelet volume in patients with type 2 diabetes mellitus”. Platelets 8 (2004): 475-478.
26. Jindal S., et al. “Platelet indices in diabetes mellitus”. Indicators of Diabetic Microvascular Complications (2011): 86.
27. Yoshimasa Aso., et al. Journal Metabolism Clinical and Experimental (2002): 471-476.
28. Refik Demirtunc A., et al. “MPV in diabetic patienys”. Journal of Diabetes and its Complications (2009): 77-152.
29. PN Papanas A., et al. “MPV in diabetic patients”. Journal of Platelets (2009).
30. Marcus E Carr. Journal of Diabetes and its Complications 15.1 (2001): 44-54.
31. Nwose EU., et al. “D-dimer identifies stages in the progression of diabetes mellitus from family history of diabetes to cardiovascular complications”. Pathology 39.2 (2007): 252-257.
32. Sid Ahmed DD. “Measurements of platelets count and platelet indices in type 2 diabetes mellitus in Sudanese patients (Doctoral dissertation, Sudan, University of Science and Technology).
33. International Diabetes Federation, Diabetes and Cardiovascular Disease: Belgium (2001).
34. Wieczor R., et al. “Type 2 Diabetes and Cardiovascular Factors Contrasted with Fibrinolysis Disorders in the Blood of Patients with Peripheral Arterial Disease”. Medicina (Kaunas) 55.7 (2019): E395. 
35. Marumo M., et al. “Inverse association betweenhabitual alcohol drinking and d-dimer in patients with type 2 diabetes mellitus”. Alcohol (2019).
36. Aberer F., et al. “Hypoglycaemia leads to a delayed increase in platelet and coagulation activation markers in people with type 2 diabetes treated with metformin only: Results from a stepwise hypoglycaemic clamp study”. Diabetes, Obesity and Metabolism 22.2 (2020): 212-221.