A Study of Correlation Between Type 2 Diabetic Dyslipidemia with Platelet Indices-MPV, P-LCR PDF

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA “A STUDY OF CORRELATION BETWEEN TYPE 2 DIABETIC DYSLIPIDEMIA WITH PLATELET INDICES-MPV, P-LCR” BY Dr. HARSHITH M. M.B.B.S., Dissertation submitted to the Rajiv Gandhi Univer...

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA “A STUDY OF CORRELATION BETWEEN TYPE 2 DIABETIC DYSLIPIDEMIA WITH PLATELET INDICES-MPV, P-LCR” BY Dr. HARSHITH M. M.B.B.S., Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In Partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE IN GENERAL MEDICINE Under the guidance of Dr. U.R. RAAJU. M.D., ASSOCIATE PROFESSOR DEPARTMENT OF GENERAL MEDICINE J.J.M MEDICAL COLLEGE DAVANGERE– 577 004. 2024 I  ACKNOWLEDGEMENT “Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow” I would like to express my heartfelt gratitude to all the people whose efforts have helped me during the course of working on this dissertation. Firstly, it is my proud privilege to express my highest feeling of obligation, and deep sense of gratitude towards my esteemed teacher and guide Dr.U.R.RAAJU M.D. ASSOCIATE Professor, Department of General Medicine, for his constant guidance and support and without whom this study would not have seen the light of this day. It gives me immense pleasure to express my gratitude to Professor and Head of Department of Medicine Dr. HARISHA E.J. M.D., for his guidance and constant inspiration during my study period. My heartly thanks to Dr. SHUKLA SHETTY, Principal, J.J.M. Medical College, Davangere, for permitting me to utilize the facilities available in the college and the hospitals for the present study. My sincere thanks and gratitude to Emeritus Professor Dr. MANJUNATH ALUR M.D., Dr. K. SRIHARSHA, Dr RAJEEV AGARWAL M.D.DNB (NEPHROLOGY), Dr.SRINATH K.V M.D for their excellent guidance and constant inspiration during my study period. It gives me immense pleasure to express my deep sense of gratitude and sincere thanks to Dr.B.G. KARIBASAPPA M.D., Dr.GURUSHANTAPPA M.D., Dr. S.S. SAWKAR M.D., Dr.SHAH ABRAR M.D., Dr. VINAY SWAMY M.D., for their guidance and encouragement. I am very much thankful to DR. PRADEEP T.V M.D., Dr. B.G. SHIVKUMAR M.D , Dr. B.G. RENUKA M.D , Dr. DARSHAN KUMAR H VI S M.D, Dr.SURESH S.R M.D., Dr.KARTHIK SASALU M.D., Dr. SAMARTH K. M.D., for their guidance and encouragement. I express my sincere thanks to Dr. MALTHESHA M.K. M.D,D.M.(CARDIO), Dr.LOHITASHWA S.B. M.D,D.M.(CARDIO), Dr. VARUN ALUR M.D,D.M.(ENDO), Dr.MOHAN R. M.D., D.M.(NEPHRO) Dr. SANJAY KUMAR M.D., D.M. (CARDIO) for their valuable advice during the course of my study. I like to extend my sincere thanks to the Superintendent, Chigateri General Hospital, Davangere District for permitting me to conduct the study and for giving necessary information. I must give sincere thanks to my PARENTS my father MANJUNATH B C, mother Mrs. SRIDEVI and my sister HASANMUKHI M for their valuable support, love and constant encouragement. I extend my gratitude to my post-graduate colleagues especially DR RAKESH SP, DR SHWETHAMBARI G, DR NAVEEN, DR PRASANNA, DR RAVIKIRANA S, DR AKSHAYA, DR SUDARSHAN, DR SUHAS, DR RAKSHITH, DR KAVAN, DR DEBLINA, DR ABHI, DR SUKUMAR, DR VINAY, DR NISHANTH, DR VARUN, DR PRANAV for the constant support and help during my study period and to all my Senior and Juniors who have helped me in preparing this dissertation. My heart full thanks to all PATIENTS who formed this study group and cooperated wholeheartedly. I thank Mr. Bharath Kumar D.G. of Sri. Maruthi DTP Centre, for their meticulous computerized layout of this dissertation. My heart full thanks to all PATIENTS who formed this study group and cooperated wholeheartedly. VII  LIST OF ABBREVIATIONS Abbreviation Full Form CHD Coronary heart disease HbA1c Glycated hemoglobin UKPDS United Kingdom Prospective Diabetes Study DCCT Diabetes Control and Complications Trial LDL Low-density lipoprotein VLDL Very-low-density lipoprotein HDL High-density lipoprotein NEFA Non-esterified fatty acids apoB Apolipoprotein B ADA American Diabetes Association SGLT2 Sodium-glucose cotransporter 2 DM Diabetes mellitus T2DM Type 2 diabetes mellitus IGT Impaired glucose tolerance IFG Impaired fasting glucose BMI Body mass index MODY Maturity onset diabetes of youth DNA Deoxyribonucleic acid SMBG Self-monitoring of blood glucose FPG Fasting plasma glucose OGTT Oral glucose tolerance test ADVANCE Action in Diabetes and Vascular Disease IX  VADT Veterans Affairs Diabetes ORIGIN Outcome Reduction with Initial Glargine Intervention ACCORD Action to Control Cardiovascular Risk in Diabetes apoAI Apolipoprotein AI apoCIII Apolipoprotein CIII apoE Apolipoprotein E CE Cholesteryl esters CETP Cholesteryl ester transfer protein IDL Intermediate-density lipoprotein LDL-R Low-density lipoprotein receptor sdLDL Small dense low-density lipoprotein TG Triglycerides MPV Mean platelet volume P-LCR Platelet large cell ratio PAI-1 Plasminogen Activator Inhibitor 1 SAID Severe autoimmune diabetes SIDD Severe insulin-deficient diabetes SIRD Severe insulin-resistant diabetes MOD Mild obesity-related diabetes MARD Mild age-related diabetes GADA Glutamic acid decarboxylase antibodies LADA Latent autoimmune diabetes in adults ACE2 Angiotensin-converting enzyme 2 CDC Centers for Disease Control and Prevention X SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 COVID-19 Coronavirus disease 2019 XI  TABLE OF CONTENTS SL CONTENTS Page No. No. 1 INTRODUCTION 1-2 2 OBJECTIVES 3 3 REVIEW OF LITERATURE 4-49 4 METHODOLOGY 50-52 5 RESULTS 53-66 6 DISCUSSION 67-71 7 CONCLUSION 72 8 SUMMARY 73-75 9 BIBLIOGRAPHY 76-94 10 ANNEXURES Annexure I: Proforma 95-98 Annexure II: Patient Consent Form 99 Annexure III: Approval Letter from Ethical Committee 100 Annexure IV: Synopsis Registration 101 Annexure V: Synopsis Approval Letter 102-103 Annexure VI: Guide Recognition Letter 104 Master Chart 105-108 XII  LIST OF TABLES Sl. Title Page No No. 1 Demographic and Basic Clinical Characteristics 53 2 Glycemic Control 55 3 Lipid Profile 56 4 Platelet Indices 58 5 Other Hematological Parameters 59 6 Renal Function 60 7 Liver Function 61 8 Thyroid Function 62 9 Medication Use 63 10 Comorbidities 65 XIII  LIST OF FIGURES SL No. FIGURES Page No. 1 Qualitative changes in lipoproteins in diabetes. 27 2 Endothelial mediators, NO, PGI2 39 XIV  LIST OF GRAPHS SL No. GRAPHS Page No. 1 Demographic and Basic Clinical Characteristics (A-B-C) 53-54 2 Distribution of study participants according to diabeties and 55 dyslipidemia 3 Distribution of study participants according to lipid profile 56 4 Distribution of study participants according to Platelet Indices 58 and dyslipidemia 5 Distribution of study participants according to Hemoglobin and 59 dyslipidemia 6 Distribution of study participants according to Renal Function 60 and dyslipidemia 7 Distribution of study participants according to Liver Function 61 and dyslipidemia 8 Distribution of study participants according to Thyroid 62 Function and dyslipidemia 9 Distribution of study participants according to Medication Use 63-64 (A&B) 10 Distribution of study participants according to Comorbidities 65 and dyslipidemia XV  ABSTRACT BACKGROUND: Dyslipidemia is a common comorbidity in patients with type 2 diabetes mellitus and is associated with an increased risk of cardiovascular complications. This study aimed to investigate the association between platelet indices (MPV and P-LCR) and diabetic dyslipidemia and to evaluate the relationship between dyslipidemia and various clinical and laboratory parameters in patients with type 2 diabetes. METHODS: A cross-sectional study was conducted on 72 patients with type 2 diabetes, divided into two groups based on the presence (n=26) or absence (n=46) of dyslipidemia. Demographic, clinical, and laboratory data were collected, including platelet indices, glycemic control, lipid profile, renal function, liver function, and thyroid function. Statistical analyses were performed to compare the two groups and assess the associations between dyslipidemia and various parameters. RESULTS: Participants with dyslipidemia had significantly higher levels of MPV (11.1 ± 1.0 fl vs. 9.5 ± 0.9 fl, p