Investigating the ultrastrctural and viscoelastic properties of whole blood, with specific focus on erythrocytes , in poorly controlled type 2 diabetes

Abstract

Type 2 diabetes mellitus is a metabolic disease associated with three main glycaemic disorders: Chronic hyperglycaemia, glycaemic variability and iatrogenic hypoglycaemia. Some comorbidities that often accompany type 2 diabetes mellitus are dyslipidemia and hypertension. There is no one particular cause of type 2 diabetes mellitus, but rather a series of risk factors that play a role in developing the disease. The most common risk factors include obesity, high blood pressure and a sedentary lifestyle. However, there are other factors such as age, polycystic ovarian syndrome, family history of type 2 diabetes and race, which may also contribute to the development of the disease. Type 2 diabetes mellitus can be diagnosed by measuring the glycated haemoglobin (HbA1c) of a patient. When the HbA1c is above a 6.5% the condition can be described as poorly controlled type 2 diabetes mellitus. There is evidence suggesting that diabetes is associated with chronic low-grade systemic inflammation. One of the signs of low-grade systemic inflammation is hypercoagulability of the blood. Hypercoagulability and the change in viscoelastic properties of the haemostatic system was the focus of this study, looking specifically in poorly controlled type 2 diabetes mellitus, by measuring erythrocyte sedimentation rate (ESR), thromboelastographic (TEG) parameters and viewing the ultrastructure of erythrocytes using scanning electron microscopy (SEM). Two groups, a healthy control group and poorly controlled type 2 diabetes mellitus group were compared in this study. ESR was used to measure inflammation and showed a significant increase in poorly controlled type 2 diabetes mellitus. Viscoelastic properties were measured with thromboelastography and displayed a decrease in clot formation time in poorly controlled type 2 diabetes mellitus as opposed to the control group. Scanning electron microscopy analysis of whole blood showed an increase in fibrin formation as well as an increase in the number of eryptotic cells in the poorly controlled type 2 diabetes mellitus group when compared to the control group. An increase of platelets was also observed in the full blood count. Results from this study showed a distinct difference between the two groups, indicating a significant change in the viscoelastic properties of individuals with poorly controlled type 2 diabetes mellitus but also an increase in the number of eryptotic cells.