Background
Increased platelet activity in type 2 diabetes mellitus (T2DM) plays a key role in the development of vascular complications. Platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (PLCR), and plateletcrit (PCT) reflect both the functional and morphological status of platelets. These indices are markers of inflammation and metabolic dysregulation, which are pivotal in diabetic vasculopathy. If platelet indices correlate with nephropathy severity, they could be used as cost-effective, accessible markers for assessing disease progression in T2DM.
Materials and methods
This cross-sectional study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India, from September 2019 to August 2021. A total of 203 patients with T2DM and nephropathy were included, diagnosed per American Diabetes Association 2017 criteria and staged using Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Nephropathy was assessed using the albumin-to-creatinine ratio, and the glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Venous blood samples were collected to measure platelet indices using the SYSMEX XN-1000 automated analyzer (Sysmex Corporation, Kobe, Japan). Statistical analysis was conducted using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 24.0, Armonk, NY), with a comparison of MPV, PDW, PCT, and PLCR across nephropathy stages performed via the Kruskal-Wallis test. Pairwise comparisons were made using the Mann-Whitney test, with a significance level set at p < 0.05.
Results
The study population had a mean age of 61.7 ± 12.0 years, with 62.1% over 60 years and a male-to-female ratio of 1.5:1. The average diabetes duration was 8.0 ± 5.2 years. The mean platelet count was 236.4 ± 112.6, and the mean values for MPV, PDW, PCT, and PLCR were 11.4 ± 1.7, 15.2 ± 3.8, 0.28 ± 0.11, and 38.9 ± 11.8, respectively. Most patients (63.1%) were in the early stages of nephropathy (stages 1-3). Significant differences in platelet indices were observed across nephropathy stages, with Kruskal-Wallis p-values of 0.027, 0.009, 0.001, and 0.007 for MPV, PDW, PCT, and PLCR, respectively. Pairwise comparisons showed that platelet indices were significantly elevated in advanced nephropathy stages (stages 4 and 5) compared to early stages (stages 1 and 2) with p < 0.05.
Conclusion
There is a significant correlation between platelet indices and the severity of nephropathy in T2DM patients. MPV, PDW, PCT, and PLCR all increase in advanced stages of nephropathy, suggesting these indices can be used as surrogate markers for assessing disease progression. Their ease of measurement and cost-effectiveness make them valuable tools in monitoring diabetic nephropathy, offering a simpler and more cost-effective alternative for monitoring disease progression.
