Antwi-Baffour et al. BMC Research Notes (2023) 16:256 BMC Research Notes https://doi.org/10.1186/s13104-023-06520-x R E S E A R C H N OT E Open Access Comparative analysis of glycated haemoglobin, fasting blood glucose and haematological parameters in Type-2 diabetes patients Samuel Antwi-Baffour1*, Benjamin Tetteh Mensah1, Dorinda Naa Okailey Armah1, Samira Ali-Mustapha3 and Lawrence Annison2 Abstract Objective Diabetes remains a major health problem, and Glycated hemoglobin (HBA1c) and fasting blood glucose (FBG) levels play important roles in its management. Also, chronic hyperglycemia coupled with high HBA1c levels impact inflammation and may alter haematological parameters in diabetes. Hence, the need to assess and correlate HBA1c and FBG levels with selected haematological parameters in patients with type-2 diabetes mellitus as the main objective of this study. The study was cross-sectional involving 384 participants. Five milliliters of blood was collected from each participant and analyzed for HBA1c, FBG levels and full blood count which were correlated statistically. Results From the data obtained and analyzed, there were statistically significant correlations between HBA1c and neutrophil count (p < 0.013), plateletcrit (p < 0.036), mean platelet volume (p < 0.019) and platelet distribution width (p < 0.002). There were also significant differences in FBG (p < 0.014), neutrophil count (p < 0.029), red cell distribution width (p < 0.046), mean platelet volume (p < 0.032) and platelet distribution width (p < 0.013) between diabetes patients with HBA1c less than 7.0% and HBA1c more than or equal to 7.0%. The outcome of the study indicates significant correlation of HBA1c with selected haematological parameters. This could make routine haematological parameters a cost-effective means of predicting poor glucose control in diabetes mellitus patients. Keywords Diabetes mellitus, Glycated haemoglobin, Haematological, Glucose *Correspondence: Samuel Antwi-Baffour ssantwi-baffour@ug.edu.gh 1Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, P. O. Box KB 143, Accra, Ghana 2Department of Medical Laboratory Technology, School of Medical Sciences, Accra Technical University, Accra, Ghana 3Department of Maternal and Child Health, School of Nursing, University of Ghana, Legon, Ghana © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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BMC Research Notes (2023) 16:256 Page 2 of 6 Introduction had other conditions such as cancer, sickle cell disease or Diabetes is a metabolic disorder of carbohydrate metab- bone marrow disorders. olism which result in persistent hyperglycemia due to either insulin deficiency, insulin resistance or both [1]. Data collection procedure According to the Diabetes Atlas (2017), an estimated Sample collection 425  million people were living with diabetes in 2017 Five milliliters of venous blood were collected from the worldwide with the global diabetes prevalence standing antecubital fossa using standard phlebotomy procedures. at 8.8% [2]. Hyperglycemia in diabetes, especially uncon- Three milliliters of the blood were transferred into an trolled diabetes, over time, results in serious damage to EDTA anticoagulant tube and two milliliters into fluoride multiple organs such as kidneys, eyes, nerves, blood ves- oxalate anticoagulant tube for analysis. sels and the heart, collectively referred to as microvascu- lar and macrovascular complications of diabetes in the Sample analysis body [3, 4]. Thus, blood glucose monitoring and regula- HbA1c determination The levels of HBA1c were deter- tion is very crucial in improving prognosis in diabetes [4]. mined on an automated Vitros chemistry analyzer (Ortho Diabetes mellitus can be diagnosed by measuring Clinical Diagnostics, U.S). For each sample, patient infor- fasting blood glucose (FBG), random blood glucose, mation was input into the analyzer and blood samples in Glycated haemoglobin (HBA1c) levels or by perform- EDTA were placed accordingly into small sample cups. ing an oral glucose tolerance test (OGTT) according to The sample cups were arranged in the same order on the WHO [5]. However, HBA1c and FBG are key mark- labelled sample trays according to the program of the ana- ers in the management of patients with diabetes. This is lyzer. They were then loaded onto the analyzer to run. because HBA1c levels represent the integrated blood glu- cose concentration over the preceding 8 to 12 weeks [6]. Again, inflammation and altered platelet functions have FBG determination Fasting blood glucose concentra- been found to be evident in diabetes, thus some research- tions were also measured on an automated Vitros chemis- ers have proposed particular haematological indices to be try analyzer. Samples in fluoride oxalate were centrifuged independent predictors of diabetes [7–9]. Some research- at 3000  rpm for 2  min to separate the plasma from the ers have also found haematological indices to be useful blood cells. Each patient plasma was poured into small indicators of vascular complications and glucose control sample cups and tested. in diabetes patients [10]. In the Ghanaian setting, data on haematological parameters and various facets of diabetes Selected haematological parameters determina- mellitus remain scanty. Only limited amount of studies tion Full blood count was performed by Mindray have reported on Glycated haemoglobin, fasting blood BC-6800 auto-haematology analyzer. Blood in EDTA glucose and haematological parameters in patients with tubes were swirled gently and arranged on the analyzer diabetes in Ghana. But a correlation between the three racks. The analyzer was set to run after which the values parameters has not been studied extensively, hence the of haemoglobin, red cell count and indices, platelet count need for this study. and indices and white cell count and differentials were recorded. Methods Aim, design and setting of the study Data analysis The aim of this study was to correlate Glycated haemo- Data obtained from the study, were analyzed using Statis- globin levels and fasting blood glucose with selected tical Package for Social Sciences (SPSS) version 24.0.0.0 haematological parameters in patients with diabetes mel- and a summary of results were presented using descrip- litus. A cross-sectional study design was employed for tive statistics of frequencies, means, medians, standard this study at the Korle-Bu teaching hospital (KBTH). deviations and percentages. Variables were compared using independent sample t-test for normally distributed Inclusion criteria data and Mann-Whitney U-test for non-normally dis- The study targeted patients of all age groups diagnosed tributed data. Spearman’s rank correlation was used to with type-2 diabetes mellitus and receiving treatment at determine correlation among the parameters. Probability the diabetes clinic of the KBTH. value of P ≤ 0.05 was considered statistically significant. Exclusion criteria Results The study excluded patients who did not have type-2 Characteristics of study participants diabetes and those with diabetes who were pregnant or A total of 384 patients with type-2 diabetes who gave their informed consent were recruited for the study. Antwi-Baffour et al. BMC Research Notes (2023) 16:256 Page 3 of 6 This consisted of 258 (67.2%) females and 126 (32.8%) Correlation of Glycated haemoglobin with selected males. The ages of the participants ranged from 24 to 79 haematological parameters among the participants years with a mean age of 59.51 ± 12.831. The mean age of according to gender female participants was 58.34 ± 12.905 and that of male With regards to female participants, there was negative participants was 61.91 ± 12.616. correlations between HbA1c and RDW-SD (p < 0.041), MPV (p < 0.005) and PDW-SD (p < 0.000) which were Comparison of study parameters between male and statistically significant, while there were both posi- female participants tive and negative correlations between HbA1c and the The results obtained for the study participants is pre- other parameters which were not statistically significant sented as Mean ± SD and Median (Q1-Q3) in the Table 1 (p > 0.05). Male participants on the other hand had nega- below. There were no statistically significant differences tive correlation between HbA1c and NEU (p < 0.006), (p < 0.05) in age and the measured parameters between and positive correlation with PLT (p < 0.009) and PCT male and female patients with diabetes. However, there (p < 0.007) all of which were statistically significant but were statistically significant differences in PLT, PCT and no statistically significant correlations were seen with the PDW-SD between male and female participants. rest of the parameters (p > 0.05) which showed both posi- tive and negative correlations (Table 2). General correlation of Glycated haemoglobin and FBG with selected haematological parameters Correlation of FBG with selected haematological When the Glycated haemoglobin and FBG were cor- parameters among the participants related with the selected haematological parameters, Statistical significance in correlation was absent between there were statistically significant correlations between FBG and haematological parameters of female partici- HbA1c and NEU (p < 0.013), PCT (p < 0.036) and PDW- pants. Male participants on the other hand recorded SD (p < 0.002) but not with the other measured param- statistically significant correlation between FBG and eters (p > 0.05). There was also no statistically significant NEU (p < 0.012) and BAS (p < 0.035), but no statistically correlation between FBG and any of the hematological significant correlation of FBG with the other parameters parameters. (p > 0.05). Comparison of FBG and haematological parameters between Glycated haemoglobin groups Table 1 A table showing the comparison of study parameters The results of Glycated haemoglobin were grouped into between male and female participants Group A (HBA1c < 7) and Group B (HBA1c ≥ 7). FBG and Sex/Parameter Female (N = 258) Male (N = 126) P-value haematological parameters results between these groups Mean ± SD Mean ± SD were then compared. There were significant differences RBC (10^12/L) 4.29 ± 0.48 4.32 ± 0.55 0.813 between the two HbA1c groups in FBG (increased in HGB (g/dL) 11.54 ± 1.18 12.11 ± 1.23 0.065 group B than A), NEU and RDW-SD (increased in group HCT (%) 36.44 ± 3.64 38.02 ± 4.03 0.103 A than B), MPV and PDW (increased in group B than MPV (fL) 8.69 ± 0.94 9.21 ± 1.36 0.069 A). The other parameters most of which were increased Median(Q1-Q3) Median(Q1-Q3) in group A as compared to group B were however not AGE 62(52–68) 63(49–71) 0.32 FBG (mmol/l) 8.6(6.8–11.1) 7.4(6.1–8.9) 0.1 statistically different between the two HbA1c groups HbA1c (%) 7.7(6.9–8.7) 7.4(6.6–9.1) 0.807 (p > 0.05) (Table 3). WBC (10^9/L) 5.08(4.02–6.28) 5.54(3.85–6.48) 0.68 NEU (10^9/L) 1.6(0.94–2.49) 1.02(0.36–2.32) 0.311 Discussion LYM (10^9/L) 2.58(2.14–3.04) 2.52(2.05–3.43) 0.945 This study included patients with type 2 diabetes mellitus MON (10^9/L) 0.5(0.37–0.74) 0.59(0.45–0.71) 0.274 with mean age of 59.1 ± 12.831 which are in line with the EOS (10^9/L) 0.05(0.03–0.07) 0.07(0.04–0.09) 0.088 global type-2 diabetes prevalence estimates of ages 20 to BAS (10^9/L) 0.05(0.03–0.07) 0.06(0.04–0.1) 0.085 79 years [1, 6]. The study also obtained a female propor- MCV (fL) 86.2(80.3–91.9) 87.8(84.3–94.4) 0.179 tion of 67.2% and male proportion of 32.8% with corre- MCH (pg) 27.6(24.8–29.2) 28.5(26.7–29.8) 0.218 sponding mean ages of 58. 34 ± 12.905 and 61.9 ± 12.616 MCHC (g/dL) 31.6(31.2–32.4) 32(31.3–32.7) 0.22 respectively, similar to other studies [7, 10, 11]. When RDW-SD (fL) 39.6(37-41.8) 39.4(37.4–42.5) 0.653 comparisons of FBG, HbA1c and selected hematological PLT (10^9/L) 254(233–303) 232(204–254) 0.006 *S parameters by gender were carried out there were statis- PCT (%) 0.23(0.2–0.26) 0.2(0.18–0.21) 0.017 *S tically significant differences in PLT, PCT and PDW-SD PDW-SD (fL) 19.8(16.1–20.8) 21.4(19.3–23) 0.009 *S between male and female participants. This finding sup- S-SIGNIFICANT port the assertion that clinically, elevated platelet counts Antwi-Baffour et al. BMC Research Notes (2023) 16:256 Page 4 of 6 Table 2 A table of the correlation of Glycated haemoglobin and Table 3 A table showing the comparison of FBG and selected haematological parameters among the participants haematological parameters between the Glycated haemoglobin Sex HbA1c/Parameter Correlation P-value groups Coefficient HbA1c Group/Parameter Group A Group B P-value Female WBC (10^9/L) 0.022 0.885 HbA1c < 7 HbA1c ≥ 7 (N = 258) NEU (10^9/L) -0.070 0.639 (N = 121) (N = 263) LYM (10^9/L) -0.080 0.595 Mean ± SD Mean ± SD MON (10^9/L) 0.150 0.315 Age 61.23 ± 7.55 58.73 ± 14.64 0.454 EOS (10^9/L) -0.206 0.165 FBG (mmol/l) 7.52 ± 1.75 9.58 ± 3.62 0.014 *S BAS (10^9/L) 0.261 0.077 RBC (10^12/L) 4.30 ± 0.47 4.30 ± 0.52 0.985 RBC (10^12/L) 0.149 0.316 HGB (g/dL) 11.92 ± 1.33 11.64 ± 1.17 0.371 HGB (g/dL) 0.045 0.763 HCT (%) 37.05 ± 3.96 36.92 ± 3.79 0.897 HCT (%) 0.069 0.646 MCV (fL) 86.50 ± 7.65 86.51 ± 8.36 0.997 MCV (fL) -0.093 0.534 HbA1c Group/Parameter Group A Group B P-value MCH (pg) -0.150 0.316 HbA1c < 7 HbA1c ≥ 7 (N = 121) (N = 263) MCHC (g/dL) -0.222 0.134 Median(Q1-Q3) Median(Q1- RDW-SD (fL) -0.299 0.041 *S Q3) PLT (10^9/L) -0.233 0.115 WBC (10^9/L) 5.78(4.08–6.72) 4.94(3.84– 0.217 PCT (%) 0.017 0.908 5.81) MPV (fL) 0.400 0.005 *S NEU (10^9/L) 2.15(1.26–3.11) 1.36(0.51– 0.029 *S PDW-SD (fL) 0.581 0.000 *S 2.35) Male WBC (10^9/L) -0.285 0.188 LYM (10^9/L) 2.54(1.92–3.17) 2.59(2.22– 0.515 (N = 126) NEU (10^9/L) -0.556 0.006 *S 3.17) LYM (10^9/L) 0.254 0.243 MON (10^9/L) 0.48(0.4–0.68) 0.53(0.42– 0.51 MON (10^9/L) -0.064 0.773 0.74) EOS (10^9/L) -0.129 0.557 EOS (10^9/L) 0.07(0.05–0.09) 0.04(0.03– 0.075 BAS (10^9/L) 0.011 0.961 0.08) RBC (10^12/L) 0.115 0.602 BAS (10^9/L) 0.04(0.02–0.08) 0.06(0.03– 0.283 0.08) HGB (g/dL) -0.062 0.779 MCH (pg) 28.6(26.85–29.8) 27.45(25.03– 0.237 HCT (%) 0.029 0.895 29.18) MCV (fL) -0.173 0.431 MCHC (g/dL) 32.05(31.28– 31.7(30.98– 0.057 MCH (pg) -0.173 0.429 33.33) 32.38) MCHC(g/dL) 0.005 0.981 RDW-SD (fL) 40.55(38.4-42.95) 38.9(36.25-41) 0.046 *S RDW-SD (fL) -0.097 0.660 PLT (10^9/L) 239.5(204- 246.5(225- 0.523 PLT (10^9/L) 0.533 0.009 *S 304.75) 286.25) PCT (%) 0.546 0.007 *S PCT (%) 0.2(0.18–0.23) 0.22(0.2–0.26) 0.056 MPV (fL) 0.178 0.418 MPV (fL) 8.4(7.78–8.98) 9(8.3–9.68) 0.032 *S PDW-SD (fL) 0.110 0.618 PDW-SD (fL) 19.2(15.68– 20.5(19.28– 0.013 *S  S-SIGNIFICANT 20.83) 22.25) S-SIGNIFICANT are frequently seen in diabetics with a long duration of disease and may be associated with the pathogenesis of tend to increase in unregulated diabetic patients). Simi- vascular diseases in diabetes. However, no statistically lar statistically significant correlations were observed by significant differences were seen among the other param- Demirtas et al., (2015) between HbA1c and PCT, MPV eters (Table 1). It was also seen that male participants had and PDW-SD [7]. higher values of some parameters compared to female With gender correlations, the female participants counterparts as seen in other studies [12, 13]. recorded significant statistical correlations between This study also obtained lower HbA1c levels in males HbA1c and RDW-SD, MPV and PDW-SD (an indication [7.4 (6.6–9.1)] than females [7.7 (6.9–8.7] and with of elevation of platelets and their indices in hyperglycae- regards to FBG, this study recorded a mean value of mia), while correlations with the other parameters were 8.6mmol/l (6.8–11.1) among females and 7.4mmol/l not statistically significant (p > 0.05). Male participants (6.1–8.9) among males with no significant difference. on the other hand had statistically significant correlation When HBA1c were correlated with the selected haema- between HbA1c and Neu, PLT and PCT only (Table 2). It tological parameters, HbA1c significantly correlated with may be worthy to note that although not significant, the Neu, PCT, MPV and PDW-SD (levels of these parameters correlation between HbA1c and HGB was a negative one Antwi-Baffour et al. BMC Research Notes (2023) 16:256 Page 5 of 6 which is similar to the result of Panda & Ambade (2018) WBC White blood cellWHO World Health Organization on the correlation between HbA1c and HGB [12]. When FBG was correlated with selected hematologi- cal parameters, no statistically significant correlation Supplementary Information was recorded. But when HBA1c results were grouped The online version contains supplementary material available at https://doi. into two (HbA1c < 7.0 and HbA1c ≥ 7.0), it was observed org/10.1186/s13104-023-06520-x. that 68.6% of the participants had their HbA1c levels at Supplementary Material 1 or above 7.0%, while a smaller proportion of 31.4% had Supplementary Material 2 their HbA1c levels below 7.0% as seen in similar studies [7]. When the two groups were compared with the other parameters, there were significant differences in FBG, Acknowledgements We are grateful to the directors and laboratory managers of the central Neu, RDW-SD, MPV and PDW between the two HBA1c laboratory of the Korle-bu Teaching Hospital for their assistance in carrying groups (Table 3). The parameters that showed significant out this study. differences are known to give fluctuating levels in diabe- Authors’ contributions tes, particularly during unregulated diabetes. Further- SA-B participated in the design, co-supervised the research, and drafted the more, the finding of higher FBG in diabetes patients with manuscript. BTM participated in the design and carried out the experimental higher HbA1c levels buttress the findings of Rohlfing et work. DNOA carried out the data analysis and editing of the manuscript. SA-M / LA participated in the supervision of the work and proof reading of the al., (2002) that there is a predictable relationship between manuscript. All authors read and approved the final manuscript. plasma glucose concentration and the levels of HbA1c which is a probable indicator of poor glucose control Funding The study was funded using the University of Ghana book and research among patients with diabetes [14]. allowances of the research team members. The University of Ghana did not play any role as far as the design of the study, collection, analysis, and Conclusion interpretation of data as well as writing of the manuscript are concerned. The findings of this current research showed significant Data Availability correlation between Glycated haemoglobin and some The datasets used and/or analyzed during the current study are available from selected haematological parameters (NEU, PCT and the corresponding author on reasonable request. PDW-SD) an indication of the effect of poor glycaemic control on these haematological parameters. The find- Declarations ings obtained in this study should make measurement of Competing interests routine haematological parameters a cost-effective means The authors declare that they have no competing interests. of predicting poor glucose regulation in patients with Ethics approval and consent to participate diabetes. The results also show that a large proportion of Ethical clearance was obtained from the ethical and protocol review patients with diabetes are not properly managing their committee of the School of Biomedical and Allied Health Science (SBAHS- blood glucose concentration well a sign of poor glycae- MLS/10575644/SA/2020-2021) as well as the institutional ethical committee of The Korle-bu Teaching Hospital. All the study details were explained to the mic control among these patients. participants and informed consent were obtained before the commencement of the study. All methods were carried out in accordance with relevant Limitations guidelines and regulations. There was limited time to carry out the study so some Consent for publication patient parameters such as blood pressure, lipid profile Not applicable. that could have helped with the study outcome could not be measured in this study. 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