Haemostatic and Haematological Parameters among Type 2 Diabetes Patients in A Tertiary Health Facility in Ondo State, Nigeria: A Cross-sectional Study

1. INTRODUCTION

The profound association of type 2 diabetes mellitus (T2DM) with a growing risk of thrombotic events cannot be overemphasized. Cardiovascular disease and thrombosis remain the major cause of death in 80% of patients with T2DM despite modern interventions, with diabetes having a prevalence rate of 4.3% in Nigeria [1-3]. In the world, generally, inflammation, insulin resistance, dyslipidaemia, thrombophilia, and obesity are higher in patients with T2DM, thereby marking the common risk factors for this disease [2, 4].

However, some additional factors of menace have been reportedly connected to the pathogenesis of cardiovascular disease in T2DM patients, thereby precipitating coagulation disruption and harassment of fibrinolysis, giving rise to an imbalance between haemostatic factors in plasma and endothelial cell surface, which is characterized by hypofibrinolysis [5-7]. The intervention of coagulation factors and co-factors can be molecularly marked by the assessment of some factors of the extrinsic and common coagulation pathway, which includes Factors I, II, V, VII, VIII and X [8-10].

Additionally, hypofibrinolysis may spring up by reason of a reduction in the expression of tissue plasminogen activator inhibitor – 1 (TPAI-1), an inhibitor and an important regulator of the fibrinolytic system which can as well serve as a molecular marker of the state of the same system [11, 12]. Previous investigations [13, 14] have reported numerous changes in haematological parameters among T2DM patients, and these include; structural and functional alterations alongside changes in the metabolism of platelets, white blood cells (WBC), red blood cells (RBC) and coagulation system, which manifest in various forms.

Although there have been various studies on the assessment of the effect of T2DM on the coagulation and fibrinolytic system, factor-specific studies are still few [15, 16] and inconsistent amongst the same population coupled with the fact that there is barely any information on the relationship between haematological parameters and coagulation/ fibrinolytic factors in T2DM subjects [17, 18]. This study was therefore aimed at comparing the levels of haemostatic and haematological parameters of T2DM and non-diabetic subjects. The study also determines the relationship of haemostatic parameters with haematological parameters amongst the T2DM subjects.

2. MATERIALS AND METHODS

3. RESULTS

4. DISCUSSION

In the present study, a greater proportion of the participants with T2DM were within the age group of 51-60 years. This was marginally higher than the observation of earlier researchers with similar studies [19, 20]. In a recent study in Ekiti State, Nigeria, a slightly higher age range of 60-69 years was reported to be dominant among individuals with T2DM [21]. It is opined that a change in metabolism has been associated with age in most diseases that are non – communicable, without the exclusion of diabetes. The tilt of the age trend toward adulthood is not farfetched from the fact that aging reportedly initiates a reduction in insulin sensitivity. Hence, glucose tolerance gradationally declines with age [22]. With regard to BM1, the majority of the study participants with diabetes were observed to be overweight as against the high record of normal weight observed among participants without diabetes. Previous researchers have also observed a similar trend [23, 24].

Excess weights have been reported as a risk factor for T2DM, thus predisposing patients to an increment in the production of some cytokines and adipokines, which contribute to insulin resistance and reduction in levels of adiponectin. It also leads to the deposition of ectopic fat in some body parts, most especially the liver [25, 26]. In addition, the study observed a higher number of male participants among those with diabetes. A similar observation has been reported by earlier investigators [27, 28]. Increased prevalence of T2DM in middle age/elderly men in which smoking has reportedly played a significant role, as has been reported earlier [29]. However, some studies have reported a high prevalence of diabetes among females, which is incongruous with the present study [30, 31].

In the present study, significantly higher levels of Factors V and VII were observed among the participants with diabetes. A similar observation has been reported by earlier investigators [18, 32]. The study findings, however, negated the observation of Erem et al. [17], who revealed no significant change in the levels of Factors V and VII in participants with diabetes when compared with those without diabetes. Generally, modification of coagulation factors has been reportedly associated with metabolic disorders, including diabetes mellitus. Thus altering the physiological mechanisms, which results in a prothrombotic state [6]. A significantly higher level of TPAI–1 was observed among the participants with diabetes in this study. A similar observation has also been reported elsewhere [33, 17]. Oxidative stress, which is pivotal in T2DM, has been attributed to a spike, a 3–fold rise in the level of TPA I – 1 by acting on Activator Protein – 1 (AP-1) binding site at s- 60/52 of the promote, which is a normal observation in the mutational analysis [34].

Results of the haematological parameters revealed significantly lower levels of red cell parameters were observed among the participants with diabetes. This observation corroborates the trend reported by Arkew et al. [35]. Generally, oxidative stress, which is connected with diabetes mellitus, does affect the antioxidant enzymes of the red blood cells. In this case, glutathione reductase level is affected, which results in a reduction in the red cell parameters, majorly haemoglobin [14, 36]. However, significantly lower levels of white blood cell count, platelet count, and some other differential leucocyte parameters, except for lymphocytes, were observed among the participants with diabetes in this study. A similar observation has been reported by other workers [37, 38].

In addition, the present study revealed a significantly positive correlation between factors V and VII in both categories of participants. A similar trend has been reported by other researchers [5, 39, 40]. It is indicated that platelets can accommodate a high proportion of TPAI-1 found in the blood. Diabetic platelets have reportedly been big and over-reactive. This might have resulted in the correlation increment observed between TPAI-1 and platelets in T2DM subjects [41]. Similarly, there was a positive correlation between the haematocrit levels and factor VII levels in diabetic subjects, which was not recorded in the non-diabetic counterpart. It has been indicated RBCS maintains a great involvement in haemoglobins both physiologically and pathologically. This is exposed by its contribution to thrombotic events through RBC and RBC precipitated microvesicle surface phosphatidylserine association with the coagulation cascade [42].

CONCLUSION

This study revealed a significant correlative increment between Factors V and VII, TPAI-1 and Factor VII in diabetic subjects. This has further established the claim that hypercoagulability is associated with T2DM. Moreover, the positive correlation observed between TPAI-1 and platelets, Factor VII and HCT, can perhaps make platelets and HCT serve as routine predictors of TPAI-1 and Factor VII levels, respectively. Hence, a definitive and easy approach toward achieving the goal of factor-specific therapy in the management of T2DM becomes more realistic. The limitation of this research is the difficulty in getting information from some illiterate subjects.

REFERENCES