European Journal of Cardiovascular Medicine

One of the most common chronic non-communicable diseases in the world, diabetes mellitus poses a serious threat to public health. The International Diabetes Federation reports that the number of persons with diabetes is still rising worldwide [1]. Chronic hyperglycemia brought on by abnormalities in insulin secretion, action, or both is the hallmark of the illness.

Persistent hyperglycemia causes structural and functional changes in blood vessels, which can lead to macrovascular problems like peripheral vascular disease, coronary artery disease, and cerebrovascular disease, as well as microvascular problems like retinopathy, nephropathy, and neuropathy [2]. In the pathophysiology of various vascular problems, platelets are essential.

Increased osmotic stress, non-enzymatic glycation of platelet proteins, oxidative stress, and endothelial dysfunction are some of the ways that hyperglycemia causes platelet activation. Increased adhesion, aggregation, and thrombotic potential are characteristics of activated platelets [3]. Bigger platelets have higher levels of prothrombotic chemicals and are more metabolically and enzymatically active.

As part of standard complete blood count testing, automated hematology analyzers provide platelet indices such MPV, PDW, and P-LCR. Average platelet size is represented by MPV, platelet size variability is indicated by PDW, and the percentage of big platelets in circulation is represented by P-LCR [4]. These metrics have become practical indicators of platelet activation.

Numerous studies have shown that diabetic individuals, especially those with poor glycemic control and vascular problems, have higher platelet indices. Data from secondary care facilities is still scarce, though. Therefore, the present study was undertaken to evaluate variations in platelet indices among patients with diabetes mellitus and assess their relationship with glycemic control and diabetic complications[5-6].

Present study is Hospital-based cross-sectional observational study. The study was conducted in the Department of Pathology in collaboration with the Department of Medicine at 220 bedded Civil Hospital Manendragarh Chhattisgarh for One year. Patients diagnosed with type 2 diabetes mellitus attending outpatient and inpatient services. Sample Size: A total of 100 patients were included. Inclusion Criteria 1. Patients aged ≥18 years. 2. Diagnosed cases of type 2 diabetes mellitus. 3. Patients willing to provide informed consent. Exclusion Criteria 1. Hematological disorders. 2. Platelet disorders. 3. Acute infections. 4. Chronic inflammatory diseases. 5. Liver disease. 6. Malignancy. 7. Pregnancy. 8. Antiplatelet therapy within the preceding two weeks. Data Collection Detailed demographic and clinical information was recorded. Venous blood samples were collected under aseptic precautions. The following investigations were performed: • Complete blood count • Platelet count • MPV • PDW • P-LCR • Fasting blood sugar • Postprandial blood sugar • HbA1c Patients were classified into: • Good glycemic control (HbA1c <7%) • Poor glycemic control (HbA1c ≥7%) Diabetic complications were assessed from clinical records and investigations. Statistical Analysis Data were analyzed using SPSS version 25. Quantitative variables were expressed as mean ± SD. Student’s t-test and Chi-square test were applied where appropriate. Statistical significance was considered at p<0.05.

Table 1: Demographic and Clinical Characteristics of Study Participants (n=100)

Mean age = 55.8 ± 10.7 years.

Table 2: Comparison of Platelet Indices According to Glycemic Control

Patients with poor glycemic control demonstrated significantly elevated MPV, PDW, and P-LCR values.

Table 3: Platelet Indices in Relation to Diabetic Complications

Significantly higher platelet activation markers were observed among patients with diabetic complications.

Table 4: Correlation of Platelet Indices with HbA1c Levels

Strong positive correlations were observed between HbA1c and platelet activation indices.

In this study, 100 individuals with type 2 diabetes mellitus who were visiting a secondary care facility had their platelet indices analyzed. It is becoming more widely acknowledged that one of the main causes of diabetic vascular problems is platelet activation. Platelet morphology and activation status can be inferred from platelet indices produced by automated hematology analyzers [7-8].

With a mean age of 55.8 years, most of the participants in our study were in the 50–60 age range. Previous studies examining platelet indices in diabetic individuals have revealed a similar age distribution [9].

In line with previous data indicating a modest male majority among hospital-attending diabetes patients, 58% of the study population consisted of male patients [10].

The current investigation showed that patients with poor glycemic control had significantly higher MPV. Patients with HbA1c <7% had mean MPV values of 9.8 fL, while those with HbA1c ≥7% had mean MPV values of 11.2 fL. There was a substantial difference (p<0.001). Larger platelets contain more dense granules and produce greater amounts of thromboxane A2, making them more thrombogenic[11].

PDW was also significantly higher among patients with poor glycemic control. Elevated PDW reflects increased heterogeneity in platelet size, which is a marker of platelet activation and turnover. Larger, more reactive platelets may be released into the bloodstream as a result of chronic hyperglycemia [12].

Patients with greater HbA1c levels had significantly higher P-LCR. This result provides more evidence for increased platelet activation in poorly managed diabetes. Numerous researchers have observed similar findings, reporting positive relationships between platelet characteristics and glycemic indices.

Patients with diabetes problems revealed significantly greater MPV, PDW, and P-LCR levels compared with those without issues. These results imply that enhanced thrombogenicity and endothelial damage caused by platelet activation lead to the development of vascular problems.

The platelet counts of the comparative groups did not differ statistically significantly. This result suggests that for evaluating vascular risk in diabetes patients, platelet function and morphology may be more useful than total platelet count.

Strong positive correlations between HbA1c and MPV, PDW, and P-LCR were found using correlation analysis. These results provide credence to the theory that increasing platelet activation is linked to worse glycemic control [13].

Increased intracellular calcium concentration, oxidative stress, advanced glycation end products, endothelial dysfunction, and heightened inflammatory responses are possible underlying processes. These elements work together to promote thrombotic propensity and platelet reactivity [14].

The fact that platelet indices are frequently obtained from whole blood count tests at no extra expense makes these findings clinically significant. They could be helpful biomarkers for identifying diabetics who are more likely to experience vascular problems.

Limitations

1. Single-centre study.
2. Relatively small sample size.
3. Cross-sectional design limits causal inference.
4. Platelet function tests were not performed.

Despite these limitations, the study highlights the potential utility of platelet indices as accessible biomarkers in diabetes management.

Platelet indices, particularly MPV, PDW, and P-LCR, are significantly elevated in patients with poorly controlled diabetes mellitus and those with diabetic complications. These indices show positive correlations with HbA1c levels and may serve as inexpensive and readily available markers of platelet activation. Routine assessment of platelet indices may help identify diabetic patients at increased risk for vascular complications and facilitate early intervention.

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