With the rising global burden of diabetes, India faces a rapidly growing epidemic, with approximately 62 million individuals currently living with the disease. This number is projected to surge beyond 85 million by 2030. Alarmingly, over 3 million people die annually due to diabetes-related complications, and in some urban Indian communities, one in every five adults is diabetic [1,2]. Type 2 Diabetes Mellitus (T2DM) is responsible for nearly 90% of the world's total diabetes, and its South Asian prevalence is expected to increase by 150% over the period from 2000 to 2025.

The International Diabetes Federation (IDF) has also projected a global increase in the number of people with diabetes from 150 million in 2000 and 415 million in 2015 to approximately 600 million by 2035. Diabetes Mellitus is a group of metabolic disorders that are characterized by persistent hyperglycemia, which is due to defects in insulin secretion, insulin action, or both. T2DM is itself a prothrombotic condition due to heightened platelet activity, which significantly enhances the risk of microvascular complication such as neuropathy, nephropathy, and retinopathy [3,4].

Insulin also plays a role in inhibiting platelet activation induced by agents like collagen, ADP, and epinephrine. Insulin resistance therefore accounts for enhanced platelet sensitivity in T2DM [5]. Platelets, as crucial hemostatic mediators, become adherent, activated, and aggragate to induce thrombosis on the occurrence of endothelial damage. These actions are deregulated in diabetic patients and are a reason for inflammation and thrombosis [6].

Platelet function and activation may be measured by various indices including platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P-LCR). MPV is a measure of mean platelet size and activity, and elevated values normally indicate increased platelet turnover or activation [7]. PDW is platelet variability in size and is a measure of anisocytosis of the platelets, while PCT is total platelet mass, which increases with both count and size. Normal P-LCR is the percentage of large, metabolically active platelets. These are simply quantifiable on automated hematology analyzers and are low-cost assessments in evaluating morphology and function of the platelets [8].

In diabetic management, optimal glycemic control is essential to prevent micro- and macrovascular complications. Glycemic control is evaluated using parameters such as fasting blood glucose (FBG), postprandial glucose (PPG), and glycosylated hemoglobin (HbA1c), and the gold standard is HbA1c. American Diabetes Association (ADA) guidelines suggest good glycemic control as an HbA1c less than 7% and fasting glucose 70–130 mg/dL [9].

Life-style interventions to manage weight, diet, and exercise are essential in the achievement of glycemic targets. Coordination with the care of other modifiable risk factors such as hypertension and dyslipidemia is also needed to counteract cardiovascular risk in T2DM [10,11].

Given the increasing recognition of platelet dysfunction as part of diabetes pathophysiology, quantification of platelet indices can provide a very important insight into the pathogenesis of vascular complications. The current study attempts to evaluate the correlation between platelet indices and various glycemic statuses among patients with T2DM.

Aims And Objectives

Aim:

To study and compare the variation of platelet indices in patients with type 2 diabetes mellitus.

Objectives:

1. To assess the values of platelet indices (MPV, PDW, PCT, P-LCR) among individuals with type 2 diabetes mellitus.
2. To correlate clinical features and glycemic status (HbA1c, FBG, PPG) with platelet indices.
3. To compare platelet indices between patients with controlled diabetes (HbA1c <7%) and those with uncontrolled diabetes (HbA1c >7%).

This prospective, observational cross-sectional study was conducted in the Department of Family Medicine, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai.

Study Design:

Cross-sectional observational study.

Study Duration:

One year (2023–2024).

Study Site:

Dr. D.Y. Patil Hospital, Nerul, Navi Mumbai.

Eligibility Criteria:

Inclusion Criteria:

• Patients aged above 18 years.
• Diagnosed cases of type 2 diabetes mellitus attending OPD or admitted to IPD.
• Patients willing to provide informed consent.

Exclusion Criteria:

• Patients with type 1 diabetes mellitus.
• Pregnant women.
• Patients on medications with antiplatelet properties.
• Patients with bone marrow disorders, thrombocytopenia, or anemia.
• Immunosuppressed patients.

Sample Size:

A total of 150 patients were enrolled in the study.

Study Procedure:

• Patients meeting the inclusion criteria were screened and shortlisted.
• Written informed consent was obtained from all participants in their preferred language (English, Hindi, or Marathi).
• Enrolled subjects were evaluated for clinical and biochemical profiles.
• Data regarding platelet indices and glycemic parameters were collected and documented for analysis.

Ethical Considerations:

The study protocol was reviewed and approved by the Institutional Ethics Committee prior to commencement.

Consent:

Written informed consent was obtained from all study participants prior to inclusion in the study.

This cross-sectional study was conducted among 150 patients with type 2 diabetes mellitus attending Dr. D.Y. Patil Hospital, Navi Mumbai, and aimed at comparing platelet indices in relation to glycemic control. Patients were categorized into two groups based on their HbA1c levels: controlled group (HbA1c < 7%, n=54) and uncontrolled group (HbA1c > 7%, n=96). The distribution of age and sex across both groups was assessed, and clinical, biochemical, and hematological parameters were studied.

In terms of age distribution, the majority of participants (59.33%) were in the 41–60 years age group, and there was no statistically significant difference in mean age between the two groups. Sex distribution revealed a nearly equal gender split overall, with no significant association between gender and glycemic control status. Mean systolic and diastolic blood pressure readings were similar across groups and showed no statistical significance.

A significant difference was observed in the mean duration of diabetes, which was longer in the uncontrolled group (5.18 ± 1.96 years) compared to the controlled group (4.04 ± 1.73 years), with a p-value of 0.0005. Complete blood count parameters including RBC count, hemoglobin, and hematocrit were within normal ranges and showed no group-based differentiation.

Analysis of platelet indices revealed significant differences between the controlled and uncontrolled groups. The uncontrolled group had significantly higher mean values for platelet count, PCT, PDW, MPV, and P-LCR, with p-values < 0.05, indicating a strong association between poor glycemic control and altered platelet morphology and activity.

Fasting and postprandial blood glucose levels were significantly higher in the uncontrolled group, consistent with their HbA1c categorization. The mean HbA1c was significantly elevated in the uncontrolled group (9.00 ± 1.50) compared to the controlled group (6.35 ± 0.22). Serum creatinine levels were mostly within normal range in the majority of cases.

Electrocardiographic findings were normal in 94% of patients, while 6% showed abnormalities. Fundus examination using direct ophthalmoscopy showed normal findings in nearly half of the patients, while mild to moderate diabetic retinopathy was seen in a considerable number of cases. Clinical symptoms like increased thirst, frequent urination, tingling sensation, and weight loss were commonly reported, especially among those with poor glycemic control.

Table 1. Age Distribution among Controlled and Uncontrolled Type 2 Diabetics

Table 1 presents the distribution of cases across different age groups in the study population stratified by glycemic control. Among patients with HbA1c <7% (controlled group), 44.44% were aged 20–40 years, 46.30% between 41–60 years, and 9.26% were above 60 years. In contrast, the uncontrolled group (HbA1c >7%) had 30.21% in the 20–40 age range, 66.67% in the 41–60 range, and only 3.13% above 60 years. The mean age in the controlled group was 44.85 ± 10.13 years and in the uncontrolled group was 44.93 ± 8.79 years. The p-value for age difference between the two groups was 0.9597, indicating no statistically significant difference.

Table 2. Sex Distribution among Controlled and Uncontrolled Type 2 Diabetics

Table 2 depicts the sex-wise distribution of patients in the study. Among the 150 participants, 71 (47.33%) were male and 79 (52.67%) were female. In the controlled group (HbA1c <7%), males constituted 55.56% and females 44.44%, whereas in the uncontrolled group (HbA1c >7%), 42.71% were male and 57.29% were female. The difference in sex distribution between the two groups was statistically not significant, with a chi-square value of 0.4267 and p-value of 0.5136.

Table 3: Blood Pressure Distribution Among Controlled and Uncontrolled Diabetes Groups

Table 3 presents the comparative evaluation of systolic and diastolic blood pressure among controlled (HbA1c <7%) and uncontrolled (HbA1c >7%) diabetic patients. The mean systolic blood pressure was 129.44 ± 9.98 mmHg in the controlled group and 131.2 ± 11.92 mmHg in the uncontrolled group. The mean diastolic blood pressure was 83.70 ± 4.68 mmHg in the controlled group and 84.32 ± 5.79 mmHg in the uncontrolled group. The observed differences in both systolic and diastolic pressures between the groups were statistically not significant.

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Table 4: Duration of Diabetes Mellitus (in Years) Among Controlled and Uncontrolled Groups

Table 4 illustrates the duration of diabetes among patients categorized by glycemic control. In the controlled group (HbA1c <7%), the majority (77.78%) had diabetes for 1–5 years, with a mean duration of 4.04 ± 1.73 years. In contrast, the uncontrolled group (HbA1c >7%) had a greater proportion (44.79%) with 5–10 years of disease duration, and a higher mean duration of 5.18 ± 1.96 years. The observed difference in duration between the two groups was statistically significant (p = 0.0005).

Table 5: Complete Blood Count Parameters in the Study Population

Table 5 presents the complete blood count parameters observed in the study participants. The mean red blood corpuscle (RBC) count was 4.85 ± 0.61 × 10⁶/mL. The mean white blood cell (WBC) count was 6.876 ± 1.81 × 10³/mL. The average hemoglobin (HGB) concentration was 13.49 ± 1.81 g/dL, and the hematocrit (HCT) value was 43.28 ± 5.4%. The red cell distribution width-coefficient of variation (RDW-CV) was 14.4 ± 1.76%, while the RDW-standard deviation (RDW-SD) was 42.32 ± 3.69 mm³.

Table 6: Comparison of Platelet Indices Between Controlled and Uncontrolled Diabetic Groups

Table 6 compares the platelet indices between patients with controlled diabetes (HbA1c < 7%) and uncontrolled diabetes (HbA1c > 7%). The mean platelet count (PLT) was 336.85 ± 81.47 × 10⁶/mL in the controlled group and 377.08 ± 54.40 × 10⁶/mL in the uncontrolled group, with a statistically significant p-value of 0.0004. Plateletcrit (PCT) was slightly higher in the uncontrolled group (0.42 ± 0.09%) compared to the controlled group (0.39 ± 0.08%), with a p-value of 0.0434. Platelet distribution width (PDW) was significantly elevated in the uncontrolled group (21.11 ± 2.95 mm³) versus the controlled group (19.04 ± 3.38 mm³) (p = 0.0001). Mean platelet volume (MPV) and platelet-large cell ratio (P-LCR) were also significantly higher in the uncontrolled group, with p-values of 0.0155 and 0.0324 respectively.

Table 7: Comparison of Blood Sugar Levels Between Controlled and Uncontrolled Diabetic Groups

Table 7 highlights the difference in mean fasting and postprandial blood glucose levels between the controlled (HbA1c < 7%) and uncontrolled (HbA1c > 7%) diabetic groups. The mean fasting blood sugar in the controlled group was 201.50 ± 33.36 mg/dL, significantly lower than the uncontrolled group which had a mean of 223.71 ± 39.82 mg/dL (p = 0.0007). Similarly, the postprandial blood sugar was also significantly lower in the controlled group (312.50 ± 51.94 mg/dL) compared to the uncontrolled group (352.00 ± 72.72 mg/dL) with a p-value of 0.0006.

Table 8: Comparison of HbA1c Levels Between Controlled and Uncontrolled Diabetic Groups

Table 8 presents the glycosylated hemoglobin (HbA1c) levels among the study participants. Out of the total 150 cases, 54 (36%) had HbA1c < 7% with a mean value of 6.35 ± 0.22, while 96 (64%) had HbA1c > 7% with a significantly higher mean value of 9.00 ± 1.50. The p-value (<0.0001) indicates a statistically significant difference between the two groups, confirming effective segregation of controlled and uncontrolled diabetics based on HbA1c levels.

Table 9: Serum Creatinine Levels among Study Participants

Table 9 displays the distribution of serum creatinine levels in the study population. Out of 150 patients, the majority—82 individuals (54.67%)—had serum creatinine levels within the 0.5–1.0 mg/dL range. Additionally, 63 patients (42.00%) had levels between 1.0–1.5 mg/dL, while only 5 patients (3.33%) had creatinine levels below 0.5 mg/dL, indicating that most participants had values within or slightly above the normal renal function threshold.

Table 10: ECG Findings Among Study Participants

Table 10 summarizes the ECG findings in the study population. Of the 150 patients evaluated, the majority—141 cases (94.00%)—had normal ECG results, whereas only 9 patients (6.00%) exhibited abnormal ECG patterns. This indicates a relatively low prevalence of cardiac electrical abnormalities in the study group.

Table 11: Fundus Examination Using Direct Ophthalmoscopy

Table 11 presents the findings of fundus examination conducted using direct ophthalmoscopy among the 150 study participants. A normal fundus was observed in 74 patients (49.33%), while 43 patients (28.67%) had mild changes. Moderate changes were seen in 30 patients (20.00%), and severe changes were present in 3 patients (2.00%), indicating varying degrees of diabetic retinopathy in the cohort.

Table 12: Clinical Features Observed Among Study Participants

Table 12 presents the distribution of various clinical features among the 150 patients with type 2 diabetes. Increased thirst was the most commonly reported symptom, present in 33 patients (22.00%), followed by increased frequency of micturition in 21 patients (14.00%) and weight loss in 19 patients (12.67%). Tingling and numbness, repeated infections, and frothy urine were each observed in 15 patients (10.00%). Blurring of vision and headache were noted in 14 cases (9.33%), while generalized weakness and excessive hunger were each reported by 11 patients (7.33%). Slow healing wounds were the least reported, found in 9 patients (6.00%).

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Table 1 shows that the majority of patients (59.33%) were in the 41–60 years age group, with no statistically significant difference in mean age between the controlled and uncontrolled diabetic groups. Table 2 presents the sex distribution, revealing that 47.33% were males and 52.67% were females, with no significant variation between the groups. Table 3 compares blood pressure readings, indicating that both systolic and diastolic pressures were similar between groups and not statistically significant. Table 4 highlights that the duration of diabetes was significantly longer in the uncontrolled group, with 44.79% having diabetes for 5–10 years compared to 22.22% in the controlled group. Table 5 reports the complete blood count values, with mean RBC at 4.85, hemoglobin at 13.49 g/dL, and RDW-SD at 42.32, showing no abnormalities across the study population. Table 6 demonstrates that all platelet indices including PLT, PCT, PDW, MPV, and P-LCR were significantly elevated in the uncontrolled diabetic group, suggesting increased platelet activation. Table 7 shows significantly higher fasting and postprandial blood sugar levels in the uncontrolled group compared to the controlled group. Table 8 confirms a statistically significant difference in HbA1c levels between the two groups, with the uncontrolled group having a higher mean value. Table 9 describes serum creatinine levels, where most patients (54.67%) had values between 0.5–1.0 mg/dL and 42% had levels in the 1.0–1.5 mg/dL range. Table 10 indicates that the majority of patients (94%) had normal ECG findings, while only 6% had abnormalities. Table 11 reveals that nearly half the patients (49.33%) had normal fundus examination, whereas 20% exhibited moderate diabetic retinopathy. Table 12 summarizes the clinical features observed, with increased thirst (22%), weight loss (12.67%), and increased frequency of micturition (14%) being the most common complaints among patients.

Diabetes mellitus is a chronic metabolic disorder associated with significant microvascular and macrovascular complications. One of the major pathophysiological mechanisms implicated in diabetic complications is a prothrombotic state marked by heightened platelet activity [12]. Hyperactive platelets, particularly larger ones, are known to release greater amounts of β-thromboglobulin, serotonin, and thromboxane A2, all of which contribute to enhanced platelet aggregation and atherosclerotic progression. This study aimed to evaluate the association between glycemic control and platelet indices among individuals with type 2 diabetes mellitus, thereby assessing their potential as prognostic indicators [13].

In the present study, the majority of the participants were middle-aged, with most cases falling in the 41–60 years category. The mean age was around 44.9 years, and there was no statistically significant difference in age distribution between the controlled and uncontrolled diabetic groups [14,15]. This aligns with earlier research that reported similar age-related findings among diabetics with and without complications, as well as in non-diabetic controls. Regarding sex distribution, the overall proportion of males and females was comparable, and no significant gender-based differences were observed between the glycemic groups. Similar trends were noted in the study by Nirangjhana et al., reflecting a balanced representation across sexes in diabetic cohorts [16,17].

A statistically significant finding in this study was the difference in diabetes duration between the two groups. The mean duration of diabetes in the uncontrolled group was significantly longer than in the controlled group, indicating that prolonged disease duration may contribute to poorer glycemic control. This observation is consistent with the findings reported by Maheswari et al., who also demonstrated longer disease duration in patients with suboptimal glycemic control [18,19].

The central focus of this study was the evaluation of platelet indices in relation to glycemic control. All the key platelet parameters platelet count (PLT), plateletcrit (PCT), platelet distribution width (PDW), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were found to be significantly higher in the uncontrolled diabetes group [20]. These findings underscore the hyperreactive state of platelets in poorly controlled diabetes. Studies such as those by Khanna et al. have reinforced these observations, reporting elevated MPV, PDW, and P-LCR levels in diabetics, especially those with microvascular complications, suggesting a strong link between platelet morphology and diabetes severity. Elevated MPV reflects the presence of larger and more active platelets, while higher PDW and P-LCR indicate greater platelet heterogeneity and increased proportions of metabolically active platelets, respectively [21].

From a clinical standpoint, common presenting symptoms in the study included increased thirst, frequent urination, weight loss, fatigue, and tingling sensations. These symptoms are characteristic of hyperglycemia and corroborate the systemic nature of diabetes. The association of increased platelet indices with such clinical features further highlights the pathological continuum from metabolic dysregulation to vascular complications [22].

The underlying mechanism behind these alterations can be traced to the impact of persistent hyperglycemia on platelet physiology. Elevated glucose levels promote glycosylation of platelet membrane proteins and enhance platelet responsiveness to aggregating agents [23]. Consequently, the presence of larger, more reactive platelets reflected in increased MPV and P-LCR has been linked to thrombotic complications, such as myocardial infarction, stroke, and other vascular events. Thus, platelet indices not only serve as markers of disease activity but may also act as early indicators of future cardiovascular risks in diabetic individuals [24,25].

In summary, this study emphasizes the potential of platelet indices as accessible, cost-effective tools to monitor glycemic control and assess the risk of complications in patients with type 2 diabetes mellitus. The consistent correlation between poor glycemic status and elevated platelet activity parameters supports their inclusion in routine evaluations, especially in resource-constrained settings.

Platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P-LCR)—serve as valuable indicators of platelet activation and are closely associated with glycemic status in patients with type 2 diabetes mellitus. This study demonstrated that these indices are significantly elevated in individuals with uncontrolled diabetes (HbA1c >7%), reflecting a prothrombotic state that predisposes to vascular complications. As glycemic levels increase, so do MPV, PDW, PCT, and P-LCR, indicating a direct and favorable correlation. These findings suggest that platelet indices, readily available through routine hematological analysis, may serve as simple, cost-effective, and non-invasive markers for assessing the risk of both microvascular and macrovascular complications in diabetes mellitus. Regular monitoring of these parameters could thus enhance early detection and preventive strategies in clinical diabetic care.

Limitations

This study was conducted as a cross-sectional analysis; hence, follow-up of patients over time to assess progression or complications could not be performed. Additionally, the sample size was relatively small and limited to a single center, which restricts the generalizability of the findings. A larger multicentric study involving diverse populations is recommended to validate and generalize the observed correlations and outcomes more robustly.

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