2Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi-6205, Bangladesh
3Department of pharmacy, Jahangirnagar University
4Lecturer, Dept. of Food Science and Technology, Henry Institute of Bioscience and Technology, Sirajganj, Bangladesh
5RMO-Cardiac surgery Square Hospitals Ltd. Dhaka, Bangladesh
6Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, 60126, Italy
7Biotechnology and Microbiology Laboratory, Department of Botany, University of Rajshahi, Rajshahi-6205, Bangladesh
Large platelet contain dense granules are metabolically and enzymatic ally more active than smaller ones and have higher thrombotic potential. Hence, increased MPV and PDW might be linked with increased thrombotic potential [7]. Platelets are a central element of the athero-thrombotic process due to their prothrombotic and proinflamatory function[8,9,10]. The association of increased MPV, PDW and decreased platelet count with disease related to endothelial dysfunction such as metabolic syndrome diabetes, coronary artery disease (CAD) and malignancy which has been shown in many studies [11-15]. Diabetes particularly DMT2 patients are exposed to the increased platelet reactivity due to multi factorial causes such as metabolic (e.g hyperglycemia, hypertriglyceridemia) and systemic abnormalities (eg. Oxidative stress, inflammation) and insulin resistance [16- 19]. In diabetic thrombocytopathy, many biomarkers have been considered for the implementation in clinical practice [20]. Most parameter of platelet activity measurement is time consuming, expensive & required high sample volume [21]. Otherwise MPV & PDW are easy to measure of platelet size, enzymatic activity and prothrombotic potential. It can be determined by routine automated hemograms at a relatively low cost [22]. An increased of MPV is one of the risk factors for micro vascular and macro vascular complications, including cardiovascular disease (CVD), retinopathy, nephropathy occur due to chronic un control hyperglycemia in diabetics also myocardial infarction, ischemic stroke and venous thromboembolism [23-29].
HbA1c is a good marker for DMT2 patients should be kept below 6.5% in order to reduce the risk of micro & macro vascular complications [30.] Improve glycemic control decrease mean platelet volume [31]. It can be suggested that reduce platelet activity by proper glycemic control may prevent or delay vascular complications in these patients.
The aim of this study was to investigate association of MPV, PDW and platelet count with short term and long term glycemic control markers. So that MPV, PDW and platelet count could be used as a predictor of diabetes patients.
Characteristics/ Parameter |
DMT2 |
Group A(n=41) |
Group B(n-46) |
P=significance |
Age (Years) |
50±12.60 |
48(25-75) |
55(35-80) |
0.265 |
Female/Male, n (%) |
37/50 |
16/25 |
21/25 |
0.011 |
FBG (mmol/L) |
10.8(6.1-18.9) |
6.9(6.1-6.85) |
11.65(6.8-18.9) |
0.255 |
RBS (mmol/L) |
17.7(6.8-29.8) |
7.25(1.20-14.20) |
17.7(6.8-29.8) |
0.955 |
HbA1c(%) |
7.05 (6.514.90) |
6.60 (6.5 -6.9) |
9.1 ( 7- 14.90) |
0.824 |
MPV (fL) |
11.7 (8.20-16.80) |
10.6(8.2-14.00) |
12.75(10.5-16.8) |
0.191 |
PDW (fL) |
13.8(7.9-23.8) |
12.5(7.9-20.8) |
15.7(12.2-23.8) |
0.012 |
Platelet count (/ccm) |
274(10-559)x103 |
268(150-559) x103 |
277(10-554) x103 |
0.190 |
Cholesterol (mg/dl) |
195(140-310) |
185(140-250) |
206(143-310) |
0.140 |
HDL (mg/dl) |
40(25-63) |
41.5(32-55) |
38.5(25-235) |
0.418 |
LDL (mg/dl) |
106.5(50-170) |
102(50-150) |
108(56-170) |
0.655 |
Triglycerides (mg/dl) |
209(11.5-1845) |
200(90-1180) |
198(11.5-1845) |
0.847 |
Creatinine (mg/dl) |
1.15(0.75-6.15) |
1.10(0.75-2.50) |
1.15(0.9-6.15) |
0.985 |
Variable |
Sensitivity (%) |
Specificity (%) |
PPV (%) |
NPV |
MPV (fL) (cutoff-9.55) |
85.19 |
30.30 |
58.23 |
12.50 |
PDW (fL) (cutoff- 14.55) |
45.77 |
67.86 |
75 |
37.25 |
Several researches found platelet count was decreased in diabetic patients as compared with non diabetic patients [33]. Platelet hypersensivity is a well-known factor to the prothrombotic state in diabetics, causing increased coagulation, impaired fibrinolysis and endothelial dysfunction. Hyperactive platelet plays a critical role in the pathophysiology of the thrombotic events leading to diabetic complications [16]. MPV is a parameter used to assess platelet size and it is a potential biomarker of platelet reactivity. Already it has been shown that longer platelet is more reactive than smaller ones [22, 34]. Several researches indicate positive correlation of RBS and HbA1c with MPV, PDW [31, 35]. However some studies have not shown any relation of RBS and HbA1c with Mean platelet volume [36, 37].
It was proposed that increase in MPV could be because of raised blood sugar effect to osmotic swelling and shorter life span of platelets in diabetic patients. Alternatively this may suggest that platelet activation is related to glycemic control [38,37]. Hyperglycemia occur non enzymatic glycation of proteins on the surface of the platelets, which decrease membrane fluidity and increase its reactivity [39]. Higher MPV responsible for increased production of young platelet due to a higher platelet turnover rate [40]. The relation between MPV and DMT2 was first reported by Sharpe and Trinick who founded a significant increase of MPV in diabetic compared with non diabetic patients [41]. This research was followed by numerous studies and with largest study conducted on 13,021 diabetic patients[14, 31, 42- 44]. Similarly, Our study results had shown significantly higher MPV in the group B compared to the group A. Those findings are mainly consistent with previous finding Besides Ozder et al. found that MPV was significantly higher in patients with HbA1c levels ≤ 7.0% than in patients with HbA1c levels ≤ 6.9. [31,45,46] this was in consonance with the result of other studies [43, 45].
All of the studies listed above investigated the association of MPV and PDW with diabetic patients. [47 Obtained values indicate the possibility of using MPV, PDW as a hematological biomarker for prediction of the diabetics disease burden in terms of vascular complications. However, Data of MPV, PDW could be used as a predictor of deterioration of glucoregulation and a marker for distinguishing those patients.
Our study indicates that it might be used as a simple, effortless and cost effective prognicator of deterioration of glucoregulation. Considering that odds of inadequate glycemic control are 2 times increased per femto-liter greater MPV. Its use especially in the Lab science diagnostics could improve the screening of high risk individuals for vascular complications. Early diagnosis and appropriate treatment could thereby delay their onset or progression. Mean platelet volume can be used as a moderate quality indicator of deterioration of glucoregulation at best cut off value 9.55 fL with sensitivity of 85.19% and specificity of 30.30%. Similarly, Platelet distribution width can be used as a moderate quality indicator of glucoregulation at best cut off value 14.55 fL with sensitivity of 45.77% and specificity of 67.86%. Finally it can be concluded that MPV & PDW are not substitute for HbA1c but it can be replace it in the circumstances of limited testing availability or limited financial resources. Due to small sample size and few in number of patient in a same area like Dhaka are considered as two limitation of this study. This study supports gluco metabolic state, poor glycemic control and platelet activity as measured by MPV and PDW. So, the study suggests that MPV, PDW and platelet count could be used as a cost effective tool to monitor diabetic mellitus.
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