Correlation of HOMA-IR and HbA1C with hematological parameters in patient with Diabetes mellitus Type II in Kirkuk city
Keywords:
HbA1C, DM Type II , RBC,WBCs Platelet count
Abstract
Objective: The aim of this study was to investigate the relationship between hematological parameters
and glycemic control in patients with type 2 diabetes mellitus (DM). Materials and Methods: This
case-control study included 50 patients with DM and 50 healthy controls. Blood samples were collected
from all participants to measure various hematological parameters and serum glucose, insulin, and
HbA1c levels. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) was calculated to
evaluate insulin resistance. Statistical analysis was performed to compare the results between the groups
and to determine the correlation between hematological parameters and glycemic control. Results: The
results showed that serum glucose, insulin, HbA1c, serum potassium, RDW, platelet count, and MID
were significantly increased in the DM group compared to the control group, while MCV was
significantly decreased. The correlation analysis showed that MID, platelet count, PCT count, and PDW
were positively correlated with serum glucose, HbA1c, and HOMA-IR, while MCV was negatively
correlated with serum glucose and HbA1c. RBC count, RDW, and PCV were positively correlated with
HbA1c and HOMA-IR. Conclusions: The study found that DM type II patients had elevated
serum glucose, insulin, HOMA IR, and HbA1C levels, as well as increased serum potassium
and MID-range absolute count, and decreased MCV but increased RDW. Platelet count, PCT
count, and PDW were positively correlated with serum glucose, HbA1C, and HOMA IR. These
hematological parameters may serve as useful markers for assessing glycemic control and
insulin resistance in DM type II patients.
References
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Chehade, J. M., Gladysz, M., & Mooradian, A. D. (2013). Dyslipidemia in type 2 diabetes: prevalence,
pathophysiology, and management. Drugs, 73(4), 327-339. doi: 10.1007/s40265-013-0023-3.
Colombo, M., Looker, H. C., Farran, B., et al. (2017). Serum concentrations of cholesterol,
apolipoprotein A-I and apolipoprotein B in a total of 1694 meat-eaters, fish-eaters, vegetarians
and vegans. European Journal of Clinical Nutrition, 71(4), 461-465. doi:
10.1038/ejcn.2016.175.
Dludla, P. V., Muller, C. J. F., Louw, J., Joubert, E., & Salie, R. (2017). Hyperglycemia-induced
oxidative stress and heart disease-cardioprotective effects of rooibos
American Diabetes Association. (2021). Classification and diagnosis of diabetes: Standards of medical
care in diabetes-2021. Diabetes Care, 44(Supplement 1), S15-S33. doi: 10.2337/dc21-S002
Bilir, B. E., Sarıkaya, R., Sarı, İ., & Yıldırım, S. (2021). The relationship between platelet indices and
insulin resistance in patients with type 2 diabetes mellitus. Journal of Clinical and Analytical
Medicine, 12(1), 48-51. doi: 10.4328/JCAM.7467
Balta, S., Demirkol, S., Celik, T., Iyisoy, A., & Kucuk, U. (2016). Red cell distribution width and
platelet-to-lymphocyte ratio as potential predictors of early mortality in diabetic ketoacidosis.
Journal of Investigative Medicine, 64(7), 1211-1216. doi: 10.1136/jim-2016-000051
Chehade, J. M., Gladysz, M., Mooradian, A. D., & Mathew, J. P. (2013). Hematological disorders in
adult patients with diabetes mellitus. Journal of Diabetes and its Complications, 27(4), 294-
301. doi: 10.1016/j.jdiacomp.2012.11.005
Dludla, P. V., Muller, C. J., & Louw, J. (2017). Potential beneficial effects of melatonin
supplementation in diabetes and obesity. Current Drug Targets, 18(13), 1537-1544. doi:
10.2174/1389450117666161115100908
Fidan-Yaylalı, G., Kızıltunç, E., & Yaylalı, A. (2017). The role of red blood cell indices in the diagnosis
of patients with diabetes mellitus. Journal of Clinical and Analytical Medicine, 8(3), 246-248.
doi: 10.4328/JCAM.4818
Matthews, D. R., Hosker, J. P., Rudenski, A. S., Naylor, B. A., Treacher, D. F., & Turner, R. C. (1985).
Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma
glucose and insulin concentrations in man. Diabetologia, 28(7), 412-419. doi:
10.1007/BF00280883
Patil, V. H., Patil, H. V., Shah, R., & Rupani, M. P. (2016). Red blood cell indices in type 2 diabetes
mellitus. Journal of Diabetes and Metabolic Disorders, 15(1), 52. doi: 10.1186/s40200-016-
0273-3
Wang, Y., Zhang, W., Jiang, W., & Chen, Y. (2020). Blood cell count and blood biochemical indexes
of type 2 diabetes mellitus patients with different levels of glycated hemoglobin. Medicine,
99(12), e19361. doi: 10.1097/MD.0000000000019361
Yang, G., Zhu, Y., Dong, X., & Wu, J. (2019). Platelet indices in relation to insulin resistance in patients
with newly diagnosed type 2 diabetes
Khan, R., Ali, K., Khan, M. W., Alam, K., & Khan, M. S. (2015). Importance of HbA1c test for
diagnosis of diabetes mellitus and screening of pre-diabetes: a review. Journal of Diabetes
Research, 2015, 1-11.
Soni, S., Badkul, R., & Bhatnagar, M. K. (2019). Mean platelet volume and platelet count as biomarkers
in patients with diabetes mellitus. Journal of Medical Science and Clinical Research, 7(5), 366-
370
Al-Rubeaan, K., Siddiqui, K., Al-Ghonaim, M., Youssef, A. M., Al-Sharqawi, A. H., & AlNaqeb, D.
(2014). Elevated levels of fasting serum glucose, insulin, HbA1c and insulin resistance
associated with the development of type 2 diabetes mellitus in Saudi women. Annals of Saudi
Medicine, 34(5), 465–471. https://doi.org/10.5144/0256-4947.2014.465
American Diabetes Association. (2022). Standards of medical care in diabetes – 2022. Diabetes Care,
45(Supplement 1), S1–S255. https://doi.org/10.2337/dc22-SINT
Kahn, B. B., Flier, J. S., & Bar, R. S. (2006). The pathophysiology of insulin resistance and its
relationship to metabolic disease. In J. E. Trosko & C. C. Chang (Eds.), Mechanisms of
Environmental Carcinogenesis (Vol. 3, pp. 27–41). Springer. https://doi.org/10.1007/978-0-
387-34751-6_2
Chen, Y., Zhang, X., Pan, B., Jin, X., Yao, H., Chen, B., Huang, Y., & Wu, Y. (2013). Serum potassium
is positively associated with insulin resistance in patients with type 2 diabetes. Endocrine,
44(2), 404–409. https://doi.org/10.1007/s12020-013-9927-1
Singh, D. K., Singh, S., Singh, B., & Singh, A. K. (2021). Serum potassium levels in patients with
uncontrolled diabetes mellitus: A cross-sectional study. Journal of Family Medicine and
Primary Care, 10(1), 166–171. https://doi.org/10.4103/jfmpc.jfmpc_1349_19
Umpierrez, G. E., Kelly, J. P., Navarrete, J. E., Casals, M. M., Kitabchi, A. E., & Hyperglycemia
Hispanic America Diabetes Outcome (HHADO) Study Group. (2002). Hyperglycemic crises
in urban blacks. Archives of Internal Medicine, 162(19), 2235–2240.
https://doi.org/10.1001/archinte.162.19.2235
Ogawa, S., Matsui, H., Kondo, Y., Nomura, M., Murakami, M., & Matsumoto, M. (2018). The
pathophysiology of hyperkalemia in diabetes mellitus. Journal of Diabetes Investigation, 9(6),
1199–1204. https://doi.org/10.1111/jdi.12827
Hjelm, K., Dahlöf, P., Hansson, P.-O., & Johansson, B. (2014). Differences in laboratory test results
between Swedish and US primary care settings: Lessons from a population-based study of type
2 diabetes mellitus. Scandinavian Journal of Primary Health Care, 32(3), 136–142.
https://doi.org/10.3109/02813432.2014.941032
Singh, R., Barden, A., Mori, T., & Beilin, L. (2015). Advanced glycation end-products: A review.
Diabetologia, 44(2), 129–146. https://doi.org/10.1007/s00125-001-0766-4
Li, X., Li, C., Liang, Z., Li, D., Wang, X., Li, S., & Chen, Y. (2015). Red blood cell distribution width:
A potential biomarker for clinical outcomes in diabetic nephropathy. International Urology and
Nephrology, 47(3), 503–508. https://doi.org/10.1007/s11255-014-0919-x
Ghosh, S., Mukherjee, S., & Chatterjee, U. (2011). Hematological profile of type 2 diabetic patients in
Eastern India. Journal of Natural Science, Biology, and Medicine, 2(2), 184–188.
https://doi.org/10.4103/0976-9668.92315
Korkmaz, M., Sahin, M., Aynioglu, O., Aksu, M., & Guzel, M. (2019). Predictive value of mid-range
absolute monocyte count in type 2 diabetes mellitus. Medical Science Monitor, 25, 3286–3293.
https://doi.org/10.12659/MSM.915566
Gomes, J. M., Costa, J. A., Alfenas, R. de C. G., & de Paula, S. O. (2014). Metabolic endotoxemia and
diabetes mellitus: A systematic review. Metabolism, 63(2), 146–159.
https://doi.org/10.1016/j.metabol.2013.10.002
Montecucco, F., Mach, F., & Schaller, K. (2013). Lymphocytes in atherosclerosis. European Journal of
Clinical Investigation, 43(5), 539–542. https://doi.org/10.1111/eci.12085
Avogaro, A., Albiero, M., Menegazzo, L., de Kreutzenberg, S., & Fadini, G. P. (2012). Endothelial
dysfunction in diabetes: The role of reparatory mechanisms. Diabetes Care, 35(4), 503–510.
https://doi.org/10.2337/dc11-1724
De Luca, G., Venegoni, E., Iorio, S., & Secco, G. G. (2018). Mean platelet volume as a marker of
platelet activation: Myth or reality in vascular medicine? Current Vascular Pharmacology,
16(2), 97–102. https://doi.org/10.2174/1570161115666180123114044
Falciglia, M., Freyberg, R. W., Almenoff, P. L., & D’Alessio, D. A. (2013). Elevated procalcitonin
levels in patients with diabetes and the association with coronary artery disease. Journal of
Clinical Endocrinology and Metabolism, 98(2), E290–E295. https://doi.org/10.1210/jc.2012-
2502
Gasparyan, A. Y., Ayvazyan, L., & Mukanova, U. (2011). Platelets and diabetes mellitus. Current
Pharmaceutical Design, 17(4), 378–384. https://doi.org/10.2174/138161211
Sakai, M., Matsumoto, K., Nishikawa, T., Suefuji, M., Nakamura, T., Inoue, H., & Inoue, K. (2015).
Hematological parameters are associated with insulin resistance and atherosclerosis in patients
with type 2 diabetes. Endocrine Journal, 62(11), 955-962.
Khorrami, A., Faraji, E., Oveisi, S., & Karimi, M. (2018). Hematocrit and risk of diabetes: A systematic
review and meta-analysis. Acta Diabetologica, 55(11), 1105-1112.
Lippi, G., Targher, G., Montagnana, M., Salvagno, G. L., Zoppini, G., Guidi, G. C., & Relationship
between red blood cell distribution width and kidney function tests in a large cohort of
unselected outpatients. Scandinavian Journal of Clinical and Laboratory Investigation, 68(3),
260-264
Wang, H., Wu, X., Zhang, G., Zhu, L., Xue, Y., Zhang, Z., & Zhang, H. (2020). Correlations between
hematological parameters and insulin resistance in type 2 diabetes mellitus patients. Medicine,
99(11), e19403.
Yu, S., Lu, M., Ma, X., Xu, C., Wang, Y., Zhang, H., & Yang, W. (2021). Association of red blood cell
distribution width with cardiovascular disease in patients with type 2 diabetes mellitus: A crosssectional study. Journal of Diabetes Research, 2021.
.44(Suppl 1), S1-S232. doi: 10.2337/dc21-S001
Chehade, J. M., Gladysz, M., & Mooradian, A. D. (2013). Dyslipidemia in type 2 diabetes: prevalence,
pathophysiology, and management. Drugs, 73(4), 327-339. doi: 10.1007/s40265-013-0023-3.
Colombo, M., Looker, H. C., Farran, B., et al. (2017). Serum concentrations of cholesterol,
apolipoprotein A-I and apolipoprotein B in a total of 1694 meat-eaters, fish-eaters, vegetarians
and vegans. European Journal of Clinical Nutrition, 71(4), 461-465. doi:
10.1038/ejcn.2016.175.
Dludla, P. V., Muller, C. J. F., Louw, J., Joubert, E., & Salie, R. (2017). Hyperglycemia-induced
oxidative stress and heart disease-cardioprotective effects of rooibos
American Diabetes Association. (2021). Classification and diagnosis of diabetes: Standards of medical
care in diabetes-2021. Diabetes Care, 44(Supplement 1), S15-S33. doi: 10.2337/dc21-S002
Bilir, B. E., Sarıkaya, R., Sarı, İ., & Yıldırım, S. (2021). The relationship between platelet indices and
insulin resistance in patients with type 2 diabetes mellitus. Journal of Clinical and Analytical
Medicine, 12(1), 48-51. doi: 10.4328/JCAM.7467
Balta, S., Demirkol, S., Celik, T., Iyisoy, A., & Kucuk, U. (2016). Red cell distribution width and
platelet-to-lymphocyte ratio as potential predictors of early mortality in diabetic ketoacidosis.
Journal of Investigative Medicine, 64(7), 1211-1216. doi: 10.1136/jim-2016-000051
Chehade, J. M., Gladysz, M., Mooradian, A. D., & Mathew, J. P. (2013). Hematological disorders in
adult patients with diabetes mellitus. Journal of Diabetes and its Complications, 27(4), 294-
301. doi: 10.1016/j.jdiacomp.2012.11.005
Dludla, P. V., Muller, C. J., & Louw, J. (2017). Potential beneficial effects of melatonin
supplementation in diabetes and obesity. Current Drug Targets, 18(13), 1537-1544. doi:
10.2174/1389450117666161115100908
Fidan-Yaylalı, G., Kızıltunç, E., & Yaylalı, A. (2017). The role of red blood cell indices in the diagnosis
of patients with diabetes mellitus. Journal of Clinical and Analytical Medicine, 8(3), 246-248.
doi: 10.4328/JCAM.4818
Matthews, D. R., Hosker, J. P., Rudenski, A. S., Naylor, B. A., Treacher, D. F., & Turner, R. C. (1985).
Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma
glucose and insulin concentrations in man. Diabetologia, 28(7), 412-419. doi:
10.1007/BF00280883
Patil, V. H., Patil, H. V., Shah, R., & Rupani, M. P. (2016). Red blood cell indices in type 2 diabetes
mellitus. Journal of Diabetes and Metabolic Disorders, 15(1), 52. doi: 10.1186/s40200-016-
0273-3
Wang, Y., Zhang, W., Jiang, W., & Chen, Y. (2020). Blood cell count and blood biochemical indexes
of type 2 diabetes mellitus patients with different levels of glycated hemoglobin. Medicine,
99(12), e19361. doi: 10.1097/MD.0000000000019361
Yang, G., Zhu, Y., Dong, X., & Wu, J. (2019). Platelet indices in relation to insulin resistance in patients
with newly diagnosed type 2 diabetes
Khan, R., Ali, K., Khan, M. W., Alam, K., & Khan, M. S. (2015). Importance of HbA1c test for
diagnosis of diabetes mellitus and screening of pre-diabetes: a review. Journal of Diabetes
Research, 2015, 1-11.
Soni, S., Badkul, R., & Bhatnagar, M. K. (2019). Mean platelet volume and platelet count as biomarkers
in patients with diabetes mellitus. Journal of Medical Science and Clinical Research, 7(5), 366-
370
Al-Rubeaan, K., Siddiqui, K., Al-Ghonaim, M., Youssef, A. M., Al-Sharqawi, A. H., & AlNaqeb, D.
(2014). Elevated levels of fasting serum glucose, insulin, HbA1c and insulin resistance
associated with the development of type 2 diabetes mellitus in Saudi women. Annals of Saudi
Medicine, 34(5), 465–471. https://doi.org/10.5144/0256-4947.2014.465
American Diabetes Association. (2022). Standards of medical care in diabetes – 2022. Diabetes Care,
45(Supplement 1), S1–S255. https://doi.org/10.2337/dc22-SINT
Kahn, B. B., Flier, J. S., & Bar, R. S. (2006). The pathophysiology of insulin resistance and its
relationship to metabolic disease. In J. E. Trosko & C. C. Chang (Eds.), Mechanisms of
Environmental Carcinogenesis (Vol. 3, pp. 27–41). Springer. https://doi.org/10.1007/978-0-
387-34751-6_2
Chen, Y., Zhang, X., Pan, B., Jin, X., Yao, H., Chen, B., Huang, Y., & Wu, Y. (2013). Serum potassium
is positively associated with insulin resistance in patients with type 2 diabetes. Endocrine,
44(2), 404–409. https://doi.org/10.1007/s12020-013-9927-1
Singh, D. K., Singh, S., Singh, B., & Singh, A. K. (2021). Serum potassium levels in patients with
uncontrolled diabetes mellitus: A cross-sectional study. Journal of Family Medicine and
Primary Care, 10(1), 166–171. https://doi.org/10.4103/jfmpc.jfmpc_1349_19
Umpierrez, G. E., Kelly, J. P., Navarrete, J. E., Casals, M. M., Kitabchi, A. E., & Hyperglycemia
Hispanic America Diabetes Outcome (HHADO) Study Group. (2002). Hyperglycemic crises
in urban blacks. Archives of Internal Medicine, 162(19), 2235–2240.
https://doi.org/10.1001/archinte.162.19.2235
Ogawa, S., Matsui, H., Kondo, Y., Nomura, M., Murakami, M., & Matsumoto, M. (2018). The
pathophysiology of hyperkalemia in diabetes mellitus. Journal of Diabetes Investigation, 9(6),
1199–1204. https://doi.org/10.1111/jdi.12827
Hjelm, K., Dahlöf, P., Hansson, P.-O., & Johansson, B. (2014). Differences in laboratory test results
between Swedish and US primary care settings: Lessons from a population-based study of type
2 diabetes mellitus. Scandinavian Journal of Primary Health Care, 32(3), 136–142.
https://doi.org/10.3109/02813432.2014.941032
Singh, R., Barden, A., Mori, T., & Beilin, L. (2015). Advanced glycation end-products: A review.
Diabetologia, 44(2), 129–146. https://doi.org/10.1007/s00125-001-0766-4
Li, X., Li, C., Liang, Z., Li, D., Wang, X., Li, S., & Chen, Y. (2015). Red blood cell distribution width:
A potential biomarker for clinical outcomes in diabetic nephropathy. International Urology and
Nephrology, 47(3), 503–508. https://doi.org/10.1007/s11255-014-0919-x
Ghosh, S., Mukherjee, S., & Chatterjee, U. (2011). Hematological profile of type 2 diabetic patients in
Eastern India. Journal of Natural Science, Biology, and Medicine, 2(2), 184–188.
https://doi.org/10.4103/0976-9668.92315
Korkmaz, M., Sahin, M., Aynioglu, O., Aksu, M., & Guzel, M. (2019). Predictive value of mid-range
absolute monocyte count in type 2 diabetes mellitus. Medical Science Monitor, 25, 3286–3293.
https://doi.org/10.12659/MSM.915566
Gomes, J. M., Costa, J. A., Alfenas, R. de C. G., & de Paula, S. O. (2014). Metabolic endotoxemia and
diabetes mellitus: A systematic review. Metabolism, 63(2), 146–159.
https://doi.org/10.1016/j.metabol.2013.10.002
Montecucco, F., Mach, F., & Schaller, K. (2013). Lymphocytes in atherosclerosis. European Journal of
Clinical Investigation, 43(5), 539–542. https://doi.org/10.1111/eci.12085
Avogaro, A., Albiero, M., Menegazzo, L., de Kreutzenberg, S., & Fadini, G. P. (2012). Endothelial
dysfunction in diabetes: The role of reparatory mechanisms. Diabetes Care, 35(4), 503–510.
https://doi.org/10.2337/dc11-1724
De Luca, G., Venegoni, E., Iorio, S., & Secco, G. G. (2018). Mean platelet volume as a marker of
platelet activation: Myth or reality in vascular medicine? Current Vascular Pharmacology,
16(2), 97–102. https://doi.org/10.2174/1570161115666180123114044
Falciglia, M., Freyberg, R. W., Almenoff, P. L., & D’Alessio, D. A. (2013). Elevated procalcitonin
levels in patients with diabetes and the association with coronary artery disease. Journal of
Clinical Endocrinology and Metabolism, 98(2), E290–E295. https://doi.org/10.1210/jc.2012-
2502
Gasparyan, A. Y., Ayvazyan, L., & Mukanova, U. (2011). Platelets and diabetes mellitus. Current
Pharmaceutical Design, 17(4), 378–384. https://doi.org/10.2174/138161211
Sakai, M., Matsumoto, K., Nishikawa, T., Suefuji, M., Nakamura, T., Inoue, H., & Inoue, K. (2015).
Hematological parameters are associated with insulin resistance and atherosclerosis in patients
with type 2 diabetes. Endocrine Journal, 62(11), 955-962.
Khorrami, A., Faraji, E., Oveisi, S., & Karimi, M. (2018). Hematocrit and risk of diabetes: A systematic
review and meta-analysis. Acta Diabetologica, 55(11), 1105-1112.
Lippi, G., Targher, G., Montagnana, M., Salvagno, G. L., Zoppini, G., Guidi, G. C., & Relationship
between red blood cell distribution width and kidney function tests in a large cohort of
unselected outpatients. Scandinavian Journal of Clinical and Laboratory Investigation, 68(3),
260-264
Wang, H., Wu, X., Zhang, G., Zhu, L., Xue, Y., Zhang, Z., & Zhang, H. (2020). Correlations between
hematological parameters and insulin resistance in type 2 diabetes mellitus patients. Medicine,
99(11), e19403.
Yu, S., Lu, M., Ma, X., Xu, C., Wang, Y., Zhang, H., & Yang, W. (2021). Association of red blood cell
distribution width with cardiovascular disease in patients with type 2 diabetes mellitus: A crosssectional study. Journal of Diabetes Research, 2021.
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