Association Between Red Cell Distribution Width and Glycemic Control in Adults With Type 2 Diabetes Mellitus: A Cross-Sectional Study in Northern Iran
Keywords:
Type 2 diabetes mellitus, Red cell distribution width, RDW, Glycated hemoglobin, HbA1c, Complete blood countAbstract
Red cell distribution width (RDW) is a routine and inexpensive hematological parameter that has recently been explored as a potential biomarker of metabolic and inflammatory disorders. This study investigated the associations between RDW, platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), and glycemic control in adults with type 2 diabetes mellitus (T2DM). Objectives: To evaluate the association between red cell distribution width and glycemic control in adults with type 2 diabetes mellitus. This cross-sectional study included 160 adults with T2DM attending diabetes clinics affiliated with Guilan University of Medical Sciences, Iran. Demographic characteristics, clinical variables, and hematological indices were collected from medical records. Glycemic control was assessed using fasting blood sugar (FBS) and glycated hemoglobin (HbA1c). Associations were evaluated using Spearman's or Pearson's correlation coefficients, and comparisons between controlled (HbA1c < 7%) and uncontrolled (HbA1c ≥ 7%) groups were performed using appropriate parametric or non-parametric tests. RDW demonstrated a weak but statistically significant positive unadjusted correlation with HbA1c (r = 0.280, P < 0.001). However, the difference in RDW between patients with controlled and uncontrolled glycemic status was not statistically significant (P = 0.188), and multivariable adjustment was not performed. Therefore, RDW should be considered an exploratory rather than a confirmatory marker. RDW showed a weak positive association with HbA1c, but its modest correlation and non-significant between-group difference indicate that it should be considered an adjunctive, rather than a substitute, marker for glycemic control. PDW and NLR were not consistently associated with glycemic control. Further prospective studies with larger populations and multivariable adjustments are warranted.
References
1. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-234. doi:10.1016/S0140-6736(23)01301-6
2. Hazar N, Jokar M, Namavari N, Hosseini S, Rahmanian V: An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996–2023. Frontiers in public health 2024, 12:1322072. doi: 10.3389/fpubh.2024.1322072
3. Sabir R, Askari S, Fawwad A, Basit A: Association between Red cells distribution width and glycemic control among people with type 2 diabetes. The Professional Medical Journal 2024, 31(03):379–385. doi: 10.29309/TPMJ/2024.31.03.5218
4. Ginoudis A, Ioannidou S, Tsakiroglou G, Kazeli K, Vagdatli E, Lymperaki E: Correlation of albumin, red cell distribution width and other biochemical and hematological parameters with glycated hemoglobin in diabetic, prediabetic and non-diabetic patients. International Journal of Molecular Sciences 2024, 25(15):8037. doi: 10.3390/ijms25158037
5. Wang J, Zhang Y, Wan Y, Fan Z, Xu R: The relationship between red blood cell distribution width and incident diabetes in Chinese adults: a cohort study. Journal of diabetes research 2020, 2020(1):1623247. doi: 10.1155/2020/1623247
6. Babker AM, Alfeel A, Suliman RS, Elshaikh RH: Association of the Red Cell Distribution Width with Complete Blood Count, Glycated Hemoglobin and Vitamin D in Patients with Type 2 Diabetes Mellitus-Across Sectional Study. Biomedical and Pharmacology Journal 2024, 17(2):881–888. doi: 10.13005/bpj/2909
7. Waghale RM, Khot RS, Joshi PP: Platelet volume indices: markers of carotid atherosclerosis in type 2 diabetes mellitus? Clinical Diabetology 2020, 9(2):103–111. doi:10.5603/DK.2020.0008
8. Chawla R, Sahu J, Punyani H, Jaggi S: Evaluation of platelet volume indices as predictive biomarkers of microvascular complications in patients with type 2 diabetes. International Journal of Diabetes in Developing Countries 2021, 41(1):89–93. doi:10.1007/s13410-020-00852-1
9. Adane T, Melku M, Worku YB, Fasil A, Aynalem M, Kelem A, Getawa S: The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Diabetes Res 2023, 2023:3117396. doi: 10.1155/2023/3117396
10. Assulyn T, Khamisy‐Farah R, Nseir W, Bashkin A, Farah R: Neutrophil‐to‐lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. Journal of clinical laboratory analysis 2020, 34(7):e23259. doi: 10.1002/jcla.23259
11. ADITHYA B, CHITRA S: Correlation of red blood cell distribution width (RDW) and hemoglobin a1c (HbA1c) levels, in patients with type 2 diabetes mellitus. International Journal of Research in Pharmaceutical Sciences 2020, 11(1):1160–1164. doi: 10.26452/IJRPS.V11I1.1951
12. Mhirig I, Harrar S, Habibi L, Sayagh S, Aboulmakarim S: Platelet and erythrocyte parameters in type 2 diabetic moroccan patients: A cross-sectional study. Journal of Laboratory Physicians 2023. doi: 10.1055/s-0043-1774811
13. Arkew M, Asmerom H, Tesfa T, Tsegaye S, Gemechu K, Bete T, Haile K: Red blood cell parameters and their correlation with glycemic control among type 2 diabetic adult patients in Eastern Ethiopia: a comparative cross-sectional study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2022:3499–3507. doi: 10.2147/dmso.s386093
14. Pretorius E, Bester J, Vermeulen N, Alummoottil S, Soma P, Buys AV, Kell DB: Poorly controlled type 2 diabetes is accompanied by significant morphological and ultrastructural changes in both erythrocytes and in thrombin-generated fibrin: implications for diagnostics. Cardiovascular diabetology 2015, 14(1):30. doi: 10.1186/s12933-015-0192-5
15. Alamri B, Bahabri A, Aldereihim A, Alabduljabbar M, Alsubaie M, Alnaqeb D, Almogbel E, Metias N, Alotaibi O, Al-Rubeaan K: Hyperglycemia effect on red blood cells indices. European Review for Medical & Pharmacological Sciences 2019, 23(5). doi: 10.26355/eurrev_201903_17259
16. Asmah R, Yeboah G, Asare-Anane H, Antwi-Baffour S, Archampong T, Brown C, Amegatcher G, Adjei D, Dzudzor B, Akpalu J: Relationship between oxidative stress and haematological indices in patients with diabetes in the Ghanaian population. Clinical diabetes and endocrinology 2015, 1(1):7. doi: 10.1186/s40842-015-0008-2
17. Roumeliotis S, Stamou A, Roumeliotis A, Theodoridis M, Leivaditis K, Panagoutsos S, Liakopoulos V: Red blood cell distribution width is associated with deterioration of renal function and cardiovascular morbidity and mortality in patients with diabetic kidney disease. Life 2020, 10(11):301. doi: 10.3390/life10110301
18. Magri CJ, Fava S: Red blood cell distribution width and diabetes-associated complications. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2014, 8(1):13–17. doi: 10.1016/j.dsx.2013.10.012
19. Taderegew MM, Woldeamanuel GG, Emeria MS, Tilahun M, Yitbarek GY, Zegeye B: Platelet indices and its association with microvascular complications among type 2 diabetes mellitus patients in northeast Ethiopia: a cross-sectional study. Diabetes, Metabolic Syndrome and Obesity 2021:865–874. doi: 10.2147/dmso.s300460
20. MI AE-G, Abdallah N, Eldars W: Mean platelet volume and platelet distribution width correlate with microvascular complications in Egyptian people with type 2 diabetes mellitus. Current Diabetes Reviews 2021, 17(8):86–93. doi: 10.2174/1573399817666210608121024
21. Bath P, Butterworth R: Platelet size: measurement, physiology and vascular disease. Blood coagulation & fibrinolysis 1996, 7(2):157–161.
22. Mohammadi M, Panahiyan P, Bashir F, Haghighi S, Ahmadi S, Olama E, Boushehri YG, Olama E, Alizadeh A, Nasab ZSH: Association Between Neutrophil‐to‐Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta‐Analysis. Health Science Reports 2026, 9(2):e71784. doi: 10.1002/hsr2.71784
23. Selvaraju V, Dharshini RP, Jayaganesh MK: B. K (2023). Neutrophil to Lymphocyte Ratio as a Denotative of Type II Diabetes Mellitus. Saudi J Pathol Microbiol, 8(3):55–59. doi: 10.36348/sjpm.2023.v08i03.003
24. Yuksel Salduz ZI, Ozder A: Neutrophil lymphocyte ratio as useful predictive tool for glycaemic control in type 2 diabetes: Retrospective, single centre study in Turkey. J Pak Med Assoc 2022, 72(6):1097–1100. doi: 10.47391/jpma.3205
25. 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. African health sciences 2019, 19(1):1602–1606. doi: 10.4314/ahs.v19i1.35
26. Gubbels Bupp MR, Jorgensen TN: Androgen-induced immunosuppression. Frontiers in immunology 2018, 9:370132. doi: 10.3389/fimmu.2018.00794
27. Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R: Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. Journal of Clinical Laboratory Analysis 2020, 34(7):e23259. doi: 10.1002/jcla.23259
28. Gurmu MZ, Genet S, Gizaw ST, Feyisa TO, Gnanasekaran N: Neutrophil–lymphocyte ratio as an inflammatory biomarker of diabetic nephropathy among type 2 diabetes mellitus patients: A comparative cross-sectional study. SAGE Open Medicine 2022, 10:20503121221140231. doi: 10.1177/20503121221140231
29. He J, Bian X, Song C, Zhang R, Yuan S, Yin D, Dou K: High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study. Cardiovascular diabetology 2022, 21(1):156. doi: 10.1186/s12933-022-01583-9
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