Alev Selek, Mehmet Sözen, Berrin Çetinarslan, Zeynep Cantürk, Emre Gezer, Yeliz Demirhan, Yonca Çetin

İnflamasyonla İlişkili Hemogram Parametreleri Diyabetes Mellitusun Bir Göstergesi Olabilir Mi?

Amaç: Subklinik kronik inflamasyon tip 2 diabetes mellitus (DM) patogenezinde önemli bir rol oynar ve inflamasyonla ilişkili hemogram parametreleri inflamasyonun bir göstergesi olarak önerilmiştir. Çalışmamızda normal oral glukoz tolerans testi (OGTT), prediyabet (preDM) ve yeni tanı konmuş tip 2 DM hastalarının hemogram parametrelerini karşılaştırmayı amaçladık. Yöntem: Şubat 2019-Aralık 2019 tarihleri arasında kurumumuzun endokrinoloji polikliniğinde 75 gr OGTT uygulanan hastaların tıbbi verileri veri tabanından elde edilmiş ve geriye dönük olarak analiz edilmiştir. Test sonuçları normal OGTT, preDM ve DM olarak 3 gruba ayrıldı. Hastaların antropometrik ölçümleri, HbA1c ve hemogram parametreleri kaydedildi. Bulgular: Çalışmaya toplam 496 vaka (246 normal OGTT, 105 preDM'li hasta ve 145 DM'li hasta) dahil edildi. Erkeklerde açlık plazma glikozu (APG) ve HbA1c düzeyleri kadınlardan daha yüksekti (p<0,05). Üç grup arasında inflamasyonla ilişkili hemogram parametreleri açısından anlamlı fark yoktu. Ancak diyabetik hastalarda APG ile MPV/trombosit sayısı oranı (MPR) arasında pozitif korelasyon vardı (r= 0,173; p= 0,037). Sonuç: İnflamasyon ile ilişkili hemogram parametreleri kolayca hesaplanabilir ve ucuz indekslerdir. Bununla birlikte, yeni tanı, HbA1c ≤% 6,5 diyabetik hastalar ve prediyabetik hastalar için güçlü belirteçler değildir.

Anahtar Kelimeler:

diabetes mellitus, prediyabet, hemogram parametreleri, HbA1c, inflamasyon

Could Inflammation Related Hemogram Parameters Be an Indicator of Diabetes Mellitus?

Objective: Subclinical chronic inflammation plays an important role in the pathogenesis of type 2 diabetes mellitus (DM) and inflammation-related hemogram parameters have been proposed as an indicator of inflammation. In our study, we aimed to compare the hemogram parameters of normal oral glucose tolerance test (OGTT), prediabetes (preDM) and newly diagnosed type 2 DM patients. Methods: Medical data of the patients who underwent 75 gr OGTT in the endocrinology outpatient clinic of our institution between february 2019 and december 2019 were obtained from the database and analyzed retrospectively. The test results were divided into 3 groups as normal OGTT, preDM and DM. Anthropometric measurements of patients, HbA1c and hemogram parameters were recorded. Results: A total of 496 cases (246 normal OGTT, 105 patients with preDM and 145 patients with DM) were included in the study. Fasting plasma glucose (FPG) and HbA1c levels of men were higher than women (p<0.05). There was no significant difference between the three groups in terms of inflammation-related hemogram parameters. But, there was a positive correlation between FPG and MPV to platelet ratio (MPR) in diabetic patients (r=0.173; p=0.037). Conclusion: Hemogram parameters associated with inflammation are easily calculated and cheap indices. However, they are not strong markers in new diagnosis, HbA1c ≤6.5% diabetic patients and prediabetic patients.

Keywords:

diabetes mellitus, prediabetes, hemogram parameters, HbA1c, inflammation,

PDF

___

Dall TM, Narayan KMV, Gillespie KB, et al. Detecting type 2 diabetes and prediabetes among asymptomatic adults in the United States: Modeling American Diabetes Association versus US Preventive Services Task Force diabetes screening guidelines. Popul Health Metr. 2014;12(1):1-14. doi:10.1186/1478-7954-12-12
Lontchi-Yimagou E, Sobngwi E, Matsha TE, Kengne AP. Diabetes mellitus and inflammation. Curr Diab Rep. 2013;13(3):435-444. doi:10.1007/s11892-013-0375-y
Goldberg RB. Cytokine and cytokine-like inflammation markers, endothelial dysfunction, and imbalanced coagulation in development of diabetes and its complications. J Clin Endocrinol Metab. 2009;94(9):3171-3182. doi:10.1210/jc.2008-2534
Zahid Kocak M, Aktas G, Erkus E, Duman TT, Atak BM, Savli H. Mean platelet volume to lymphocyte ratio as a novel marker for diabetic nephropathy. J Coll Physicians Surg Pakistan. 2018;28(11):844-847. doi:10.29271/jcpsp.2018.11.844
Bilgin S, Aktas G, Zahid Kocak M, et al. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. Aging Male. 2019. doi:10.1080/13685538.2019.1632283
Sayiner ZA, Eraydin A, Atakur S ÖM. The Relationship Between Microvascular Complications in Type 2 Diabetes with Mean Platelet Volume, Red Blood Cell Distribution Width, Neutrophile Lymphocyte Ratio. Turkiye Klin J Intern Med. 2017;2(3):113-7. doi:10.5336/intermed.2017-57111
Brusco G, Di Stefano M, Corazza GR. Increased red cell distribution width and coeliac disease. Dig Liver Dis. 2000;32(2):128-130. doi:10.1016/s1590-8658(00)80399-0
World Health Organization. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus Abbreviated Report of a WHO Consultation.; 2011.
Böni-Schnetzler M, Meier DT. Islet inflammation in type 2 diabetes. Semin Immunopathol. 2019;41(4):501-513. doi:10.1007/s00281-019-00745-4
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. J Am Med Assoc. 2001;286(3):327-334. doi:10.1001/jama.286.3.327
Stehouwer CDA, Gall MA, Twisk JWR, Knudsen E, Emeis JJ, Parving HH. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: Progressive, interrelated, and independently associated with risk of death. Diabetes. 2002;51(4):1157-1165. doi:10.2337/diabetes.51.4.1157
Papanas N, Symeonidis G, Maltezos E, et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets. 2004;15(8):475-478. doi:10.1080/0953710042000267707
Aktas G, Kocak MZ, Taslamacioglu Duman T, et al. Mean Platelet Volume (MPV) as an inflammatory marker in type 2 diabetes mellitus and obesity. Bali Med J. 2018;7(3). doi:10.15562/bmj.v7i3.806
Ulutas KT, Dokuyucu R, Sefil F, et al. Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: A marker for atherosclerosis? Int J Clin Exp Med. 2014;7(4):955-961.
Sefil F, Ulutas KT, Dokuyucu R, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res. 2014;42(2):581-588. doi:10.1177/0300060513516944
Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, Savli H. Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci. 2019;19(1):1602-1606. doi:10.4314/ahs.v19i1.35
Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: Systematic review and meta-analysis. BMJ. 2016;355. doi:10.1136/bmj.i5953
Shin DH, Rhee SY, Jeon HJ, Park JY, Kang SW, Oh J. An increase in mean platelet volume/platelet count ratio is associated with vascular access failure in hemodialysis patients. PLoS One. 2017;12(1). doi:10.1371/journal.pone.0170357
Ates S, Oksuz H, Dogu B, Bozkus F, Ucmak H, Yanıt F. Can mean platelet volume and mean platelet volume/platelet count ratio be used as a diagnostic marker for sepsis and systemic inflammatory response syndrome? Saudi Med J. 2015;36(10):1186-1190. doi:10.15537/smj.2015.10.10718
Duman TT, Aktas G, Atak B, Kocak MZ. Is Mean Platelet Volume to Platelet ratio a promising indicator of diabetic regulation in type 2 diabetes mellitus? J Med Res. 2018;4(3):137-139. www.medicinearticle.com. Accessed May 14, 2020.
Toryila J., Amadi K, Adelaiye A. Platelet counts and mean platelet volume amongst elderly Nigerians. Sci World J. 2010;4(1). doi:10.4314/swj.v4i1.51831
Li J, Chen Q, Luo X, et al. Neutrophil-to-Lymphocyte Ratio Positively Correlates to Age in Healthy Population. J Clin Lab Anal. 2015;29(6):437-443. doi:10.1002/jcla.21791