Evaluation of Red Blood Cell Parameters as a Biomarker for Long-Term Glycemic Control Monitoring Among Type 2 Diabetic Patients in Southwest Ethiopia: A Cross-Sectional Study

Abstract

Background: Type 2 Diabetes Mellitus (T2 DM) is a common type of DM characterized by hyperglycemia. Glycation of hemoglobin and related proteins in DM can affect the physiological and structural properties of red blood cells. Although glycated hemoglobin (HbA1c) test continues to be the gold standard for the assessment of long-term glycemic control accessibility and affordability of the test in routine diagnosing service are still limited in developing countries. Hence, this study was aimed to assess red blood cell parameters as a biomarker for long-term glycemic monitoring among T2 DM patients.Methods: Facility-based cross-sectional study through a consecutive sampling technique was conducted among 124 T2 DM patients at the chronic illness follow-up clinic of Jimma Medical Center (JMC) from July 27 to August 31, 2020. A structured questionnaire was used to collect socio-demographic and clinical-related data. Five milliliters of the blood specimen was collected from each eligible T2 DM patient. HbA1c and red blood cell parameters were determined by Cobas 6000 and DxH 800 fully automated analyzers respectively. Data were entered into Epi-data software version 3.1 and exported to SPSS 25 version for analysis. Independent t-test and Pearson’s correlation coefficient were used to address the research questions. A P-value < 0.05 was considered statistically significant. Results: The mean age of study participants was 51.84± 11.6 years. 60.5% of T2 DM patients were in poor glycemic control. There was a significant mean difference between good and poor glycemic controlled T2 DM patients in red blood cell count (4.79±0.5 vs 4.38±0.8), hemoglobin (14.13±1.4 vs 13.60±1.6), mean corpuscular volume (89.52±4.7 vs 92.62±7.5), mean corpuscular hemoglobin (29.63±1.6 vs 30.77±2.9), and red cell distribution width (13.68±1.1 vs 14.63±1.2) respectively. Red blood cell count was inversely correlated (r=-0.280, p=0.002) with HbA1c while mean corpuscular volume (r=0.267, p=0.003), mean corpuscular hemoglobin (r=0.231, p=0.010), and red cell distribution width (r= 0.496, p=0.000) were positively correlated with level of HbA1c. Conclusion: Red cell count, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width could be useful indicators to monitor the glycemic status of T2 DM patients instead of HbA1c, though large prospective studies should be considered.