Comparison of Glycated Haemoglobin with Coagulation and Biochemical Profile of Patients with Type II Diabetes Mellitus

Comparison of Glycated Haemoglobin with Coagulation and Biochemical Profile of Patients with Type II Diabetes Mellitus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Comparison of Glycated Haemoglobin with Coagulation and Biochemical Profile of Patients with Type II Diabetes Mellitus Samuel Antwi-Baffour, Benjamin Tetteh Mensah, Dorinda Naa Okailey Armah, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4378442/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Persistent hyperglycaemia in diabetes can lead to abnormal blood clotting due to the glycation of haemoglobin and other clotting proteins. Shortened activated partial thromboplastin time (APTT), prothrombin time (PT), altered levels of other clotting factors, and biochemical markers may indicate a higher risk of blood clot formation, which can contribute to vascular diseases and impact kidney function. This study examined 150 diabetic patients to analyse how their clotting and biochemical profiles were affected by glycemic control. Data on participants' demographics, socioeconomic status, and lifestyle were collected. Blood samples were analysed using automated coagulation and chemistry analysers. Results Participants were divided based on their glycated haemoglobin (HbA1c) levels with HbA1c < 6.5 indicating good and HbA1c ≥ 6.5 indicating poor glycemic control. Coagulation tests showed that patients with poorly controlled T2DM had shorter APTT and PT and decreased INR compared to those with good control. However, fibrinogen and D-dimer levels were elevated in all participants. While renal function markers were increased, the differences between the groups were insignificant. Furthermore, systolic blood pressure was significantly higher in poorly controlled T2DM patients. These findings suggest that individuals with poorly controlled T2DM may be more susceptible to thrombus formation due to increased activation of prothrombotic coagulation factors. Hyperglycemia Coagulation Prothrombotic Diabetes mellitus Glycated Haemoglobin INTRODUCTION Diabetes mellitus (DM) is a disease in which the body’s ability to produce or respond to insulin is impaired, leading to abnormal metabolism of carbohydrates and elevated levels of glucose in the blood [ 1 – 3 ]. Type 2 diabetes mellitus (T2DM) is particularly prevalent globally, with its incidence expected to rise significantly due to factors like obesity and metabolic syndrome [ 4 , 5 ]. The International Diabetes Federation estimated that in 2013, 382 million adults aged 20–70 years worldwide had T2DM, with 80% of those affected living in low- and middle-income countries [ 4 , 5 ]. This number is expected to rise to 592 million by 2035 [ 4 , 5 ]. In Ghana, the prevalence is reported to be 6.3% and is expected to rise rapidly [ 6 ]. Hyperglycemia, a hallmark of T2DM, triggers biochemical changes affecting protein, lipid, and carbohydrate metabolism [ 7 ]. Additionally, T2DM is a known risk factor for cardiovascular disorders, with approximately 80% of diabetic individuals facing the risk of thromboembolic cardiovascular disease [ 5 ]. Moreover, uncontrolled diabetes can lead to severe organ damage, termed microvascular and macrovascular complications [ 8 , 9 ]. Regular monitoring and regulation of blood glucose levels play a critical role in enhancing the prognosis of diabetes. Glycated haemoglobin (HbA1c) is a valuable tool in this regard as it reflects average blood sugar levels over the preceding 2 to 3 months, offering a more comprehensive assessment compared to fasting blood glucose [ 9 ]. Coagulation abnormalities are common in T2DM, with increased clotting factors and reduced antithrombin III, protein C, and protein S levels contributing to hypercoagulability [ 5 , 10 , 11 ]. This condition accelerates atherosclerosis and elevates cardiovascular disease risk [ 11 ]. Studies indicate alterations in coagulation factors like fibrinogen, PT, APTT, INR, and D-dimer due to poor glycaemic control [ 12 – 14 ]. However, comprehensive research on the coagulation balance in diabetes, especially in Sub-Saharan Africa, remains limited. Therefore, this study aims to explore the impact of poor glycemic control on coagulation and biochemical parameters in T2DM patients, filling crucial knowledge gaps in this field. Methods Aim, design and setting of the study. The study aimed to determine the effect of poor glycemic control on coagulation and biochemical parameters to reflect renal function status among patients with T2DM. The study was a cross-sectional one involving 150 recruited from the Diabetic Clinic of the Korle-Bu Teaching Hospital (KBTH). The study was conducted from January 2019 to December 2019. Data Collection. Sample/data collection procedure. Participants completed a questionnaire for the collection of sociodemographic characteristics. Their heights and weights were then measured for the calculation of BMI. They then observed an overnight fast of 8 to 12 hours before their blood samples were collected for the fasting blood glucose (FBG) and HBA1c tests. Venous whole blood (8 ml) was taken, and 2 ml was placed into test-tubes containing sodium citrate as an anticoagulant; 2 ml was placed in EDTA tubes, 2 ml in SST tubes and 2 ml in fluoride tubes. The samples were sent to the Central Laboratory of the KBTH for analysis. Sample analysis. Coagulation parameter measurements. The blood samples in citrate were centrifuged at a speed of 3000rpm for 15 minutes to obtain plasma which were dispensed into loading trays and run by the Automated Blood Coagulation Analyser CS-1600 produced by Sysmex West and Central Africa Ltd. This was done by placing the loaded trays into the loading chamber and the Analyser set to run. The results for APTT, PT, D-dimer, fibrinogen, and INR were obtained from this analysis. Fasting blood glucose measurements. Fasting blood glucose concentrations were also measured on an automated Vitros chemistry analyser (Ortho Clinical Diagnostics, U.S.). Patient blood samples in fluoride oxalate tubes were centrifuged at 3000rpm for 2 minutes and the plasma poured into small sample cups, run and the results of each patient recorded. The participants’ diabetes statuses were classified according to the following diagnostic criteria: Normal: FBG: 3.6–6.0 mmol/l (65–108 mg/dl). Diabetes fasting blood glucose: (FBG): ≥7.0 mmol/l (126 mg/dl). Glycated haemoglobin (HbA1c) determination. The levels of HBA1c in the participants were also determined on the automated Vitros chemistry analyser. For each sample, blood samples in EDTA were poured into small sample cups and arranged on labelled sample trays according to the programme of the analyser. The sample trays were loaded on the analyser and run. After the run, the values of glycated haemoglobin for each patient were recorded. Determination of selected biochemical parameters. The biochemical parameters were also measured on the automated Vitros chemistry analyser. Here, participants’ blood samples in the SST tube were centrifuged at 3000rpm for 5 minutes and serum obtained poured into small sample cups and run, after which the results of each patient were recorded. • Data analysis The data obtained were analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to analyse categorical and continuous variables. Student’s t test was employed to determine mean FBG differences among the two groups. The odds of diabetes among the populations were determined using unadjusted and adjusted logistic regression. A P value < 0.05 was interpreted as significant. Results Sociodemographic information of participants and controls The participants were categorized into two groups based on their HbA1c levels: Group A (HbA1c ≥ 6.5), denoting poor glycemic control, and Group B (HbA1c < 6.5), denoting good glycemic control. Group A had an average age of 59.36 years, significantly higher than the average age of 50.83 years in Group B. Moreover, Group A had a higher proportion of females (73.3%) compared to males, while Group B had more males (80.0%) than females. Most participants in Group A belonged to the age group of 60–80 years, whereas most participants in Group B were aged between 40–60 years. In both groups, the highest proportion of participants were married and had basic education levels. Additionally, informal employment was more common in both groups, with 78.6% in Group A and 69.3% in Group B (Table 1 ). Table 1 Sociodemographic information of participants Variables Group A (n = 75) Group B (n = 75) p value Average age (years) 59.36 ± 13.475 50.83 ± 14.049 0.0002 Gender 0.0001 Male 20 (26.7) 60 (80.0) Female 55 (73.3) 15 (20.0) Age Group 0.003 0–40 10 (13.3) 19 (25.3) 40–60 25 (33.3) 36 (48.0) 60–80 40 (53.4) 20 (26.7) Marital status 0.0476 Single 11 (14.7) 13 (17.3) Married 34 (45.3) 47 (62.7) Divorced 10 (13.3) 7 (9.3) Widowed 20 (26.7) 8 (10.7) Educational Level 0.5124 No Formal Education 6 (8.0) 12 (16.0) Basic 44 (58.7) 39 (52.0) Secondary 19 (26.7) 20 (25.3) Tertiary 5 (6.7) 5 (6.7) Occupation 0.2444 Unemployed 6 (8.0) 5 (6.7) Formal 10 (13.3) 18 (24.0) Informal 59 (78.6) 52 (69.3) Biochemical profile of Participants. HBA1c was analysed to check for glycemic control. And as stated above, all the participants were placed in two groups of A and B according to their HBA1c results. Subsequently, all other biochemical parameters measured showed higher values in those in group A than those in group B, although the differences were not significant (Table 2 ). Table 2 A table of the biochemical profiles of the participants. Type of analytes Group A (n = 75) Group B (n = 75) p value Median (Q1–Q3) Median (Q1–Q3) HBA1c 7.7 (6.5–9.1) 5.4 (4.6–6.4) 0.314 Na + (mmol/L) 145.0 (138–148) 141.5 (138.0–144.0) 0.973 K + (mmol/L) 4.90 (4.00–5.78) 4.30 (3.93–4.71) 0.420 Cl – (mmol/L) 105.5 (100–110.0) 102 (100–105) 0.259 UREA (mmol/L) 7.1 (2.63–9.98) 3.6 (2.4–6.88) 0.492 CREAT ( µ mol/L) 81.5 (64.25–156.75) 77.5 (57.25–147.75) 0.338 p < 0.05 was considered significant. Coagulation, biochemical and anthropometric profiles of the Participants. Table 3 shows the coagulation profile and anthropometric measurements of the participants. All coagulation parameters except fibrinogen showed significant differences (P = 0.0001). The FBG results also showed a significant difference between the groups (p = 0.0001). With the blood pressure measurement, SBP showed a significant difference between group A and group B. Although those in group A had average high DBP and BMI results compared with those in group B, the differences were not significant (p = 0.294 and p = 0.371, respectively) (Table 3 ). Table 3 A Table of Coagulation, Biochemical and Anthropometric Profiles of Participants. Variables Group A Group B p value AGE 59.36 ± 13.475 50.83 ± 14.049 0.0150 PT 11.385 ± 1.2477 12.932 ± 2.7179 0.0001 APTT 26.685 ± 4.5689 34.317 ± 5.7989 0.0001 INR 1.0185 ± 0.12046 1.1662 ± 0.26526 0.0001 Fibrinogen 2.62 ± 0.28 2.45 ± 0.20 0.0001 D-Dimer 0.75 ± 0.11 0.45 ± 0.16 0.0001 FBG 11.532 ± 5.0617 4.350 ± 7.175 0.0001 SBP (mmHg) 147.29 ± 32.90 119.76 ± 15.9 0.0001 DBP (mmHg) 81.18 ± 19.26 77.40 ± 11.20 0.1439 BMI (kg/m 2 ) 22.21 ± 2.21 21.23 ± 3.62 0.0472 Discussion Diabetes is associated with cardiovascular issues like heart attacks, strokes, and peripheral arterial disease [ 7 ]. The precise causes of these problems are complex and not fully understood but involve abnormalities in blood clotting processes. Both arterial and venous clotting, previously thought to have distinct causes, are now understood to share similarities in their origins. Atherothrombosis, a type of clotting seen in diabetes, is likely due to the increased clotting tendency seen in diabetic patients. This suggests that diabetes creates a prothrombotic (blood clot-promoting) state, particularly in type 2 diabetes, which affects clot formation and dissolution processes [ 15 ]. The study aimed to investigate how blood sugar levels affect clotting and biochemical factors in type 2 diabetes patients. It examined 150 participants, dividing them into poorly controlled (A) and well-controlled (B) groups based on their HbA1c levels. Results showed that poorly controlled diabetes patients had shorter clotting times, lower INR levels, and higher fibrinogen and D-dimer levels, indicating a tendency towards excessive blood clotting. This suggests that poorly controlled type 2 diabetes patients are at a higher risk of thromboembolic events. These findings are consistent with other studies globally and in Ghana [ 4 , 5 , 12 , 15 , 16 ]. However, some previous studies showed conflicting results regarding clotting factors in diabetes patients, possibly due to sample size and demographic differences [ 17 , 18 ]. Group A, consisting of patients with poorly controlled diabetes, exhibited significantly higher FBG levels compared to Group B, which had better glycemic control. Moreover, Group A showed higher SBP values compared to Group B. Although average DBP and BMI were higher in Group A, these differences were not statistically significant. Additionally, levels of fibrinogen and D-dimer were elevated in Group A, while INR levels were decreased compared to Group B, supporting the prothrombotic episodes seen in poorly controlled diabetes. Furthermore, urea and creatinine levels were higher in Group A compared to Group B members, suggesting potential kidney function impairment associated with poorly controlled diabetes. Glycated haemoglobin determination has been the gold standard for the evaluation of glycaemic control in diabetic patients for more than three decades [ 19 – 21 ]. In this study, it was found that the HBA1c correlated with coagulation parameters such that those with high HBA1c (group A) showed a coagulation pattern that indicated hypercoagulability, while those (group B) with normal HBA1c values showed normal coagulation parameters and patterns. The differences were also significant. Furthermore, all the other biochemical parameters measured to ascertain whether glycemia levels have any effect on renal function showed high values in those in group A compared with those in group B, although the differences were not significant. However, the lack of proper glycaemic control among the group A members may have an adverse effect on their kidneys. None of the participants was on anticoagulants. For limitations, risk factors such as increased LDL, smoking, obesity, physical activity, and unhealthy diet were not identified or accounted for among the participants. Conclusion The study found that patients with poorly controlled diabetes had shorter clotting times and lower INR levels, indicating a tendency towards excessive blood clotting. Additionally, they had higher levels of fibrinogen and D-dimer, markers of blood clot formation and breakdown. These patients also showed elevated levels of FBG, blood pressure, and BMI. The study suggests that diabetes patients, especially those with poor control, are at increased risk of excessive blood clotting, leading to potential thrombotic events. Regular clotting tests may be necessary to identify and prevent cardiovascular complications in diabetes. Abbreviations APTT Activated partial prothrombin time BMI Body mass index CVD Cardio-vascular disease DM Diabetes mellitus DBP Diastolic blood pressure ED Endothelial dysfunction EDTA Ethylenediaminetetraacetic acid FBG Fasting blood glucose HbA1c Glycated haemoglobin INR International normalize ratio KBTH Korle-bu Teaching Hospital LDL Low density lipoprotein NIDM Non-insulin dependent PT Prothrombin SBP Systolic blood pressure SPSS Statistical package for social sciences T1DM Type 1 diabetes mellitus T2DM Type 2 diabetes mellitus Declarations Ethics approval and consent to participate. Ethical clearance was obtained from the ethical and protocol review committee of the College of Health Sciences (CHS-Et/M.1-P5.3/2018-2019) as well as the institutional ethical committee of The Korle-Bu Teaching Hospital. All the study details were explained to the participants, and informed consent was obtained before the commencement of the study. Consent for publication. Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Funding The study was funded using the University of Ghana book and research allowances of the research team members. The University of Ghana did not play any role in the design of the study; the collection, analysis, and interpretation of data; or the writing of the manuscript. Author’s contribution SAB participated in the design, co-supervised the research, and drafted the manuscript. BTM participated in the design of the study, conducted experimental work, and proof reading of the manuscript. DNOA and LA conducted the data analysis and editing of the manuscript. SAM and ILN participated in the supervision of the work and proof reading of the manuscript. All authors read and approved the final manuscript. Acknowledgements We are grateful to the directors and laboratory managers of the Central Laboratory at the Korle-Bu Teaching Hospital. Additionally, we thank the staff and directors of the Diabetic Clinic of the Korle-Bu Teaching Hospital for their assistance in carrying out this study. References American Diabetes Association; Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1. 2014;37(supplement _1); S81-S90. doi:10.2337/dc14s081. Ginter E, Simko V. Type 2 diabetes mellitus, pandemic in 21st century. Adv. Exp. Med. Biol. 2013;doi:10.1007/97814614544106. DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ et al. Type 2 diabetes mellitus. Nat. Rev. Dis. Primers. 2015; 1:15019. Tripodi A, Branchi A, Chantarangkul V, Clerici M, Merati G, Artoni A, et al. Hypercoagulability in patients with type 2 diabetes mellitus detected by a thrombin generation assay. J. Throm. Thrombolysis. 2011; doi:10.1007/s1123901005060. Hazari MAH, Ram Reddy, B, Uzma N, Santhosh Kumar B. Cognitive impairment in type 2 diabetes mellitus. Int. J. Diabetes Mellit. 2015;doi:10.1016/jijdm201101001. Amoah AGB, Owusu SK, Adjei S. Diabetes in Ghana: A community based prevalence study in Greater Accra. Diabetes Res. Clin. Pract. 2002; doi:10.1016/s01688227(01)003746. Coccheri S. Approaches to prevention of cardiovascular complications and events in diabetes mellitus. Drugs. 2007; doi:10.2165/0000349520076707000005. Marchetti P, Cnop M, Eizirik DL. Prancreatic α Cells are Resistant to MetabolicStress-Induced Apoptosis in Type 2 Diabetes. EBioMedicine. 2015;2:378-85. Whiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Alas: Global Estimate of the Prevalence of Diabetes for 2011 and 2030. Diabetes Res. Clin. Pract. 2011;94:311-321. Remkova A. (2006). Diagnostic approach to hypercoagulable states. Bratisl. Lek. Listy. 2006; 107 (8):292–5. Carr ME. Diabetes mellitus: A hypercoagulable state. J. Diabetes Complicat. 2001;doi:10.1016/s10568727(00)00132. Asakawa H, Tokunaga K, Kawakami F. (2000). Elevation of fibrinogen and thrombin-antithrombin III complex levels of type 2 diabetes mellitus patients with retinopathy and nephropathy. J. Diabetes Complicat. 2000; doi:10.1016/s10568727(00)000751. Ceriello A. Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects. Diabetologia. 1993;36. Sauls DL, Banini AE, Boyd LC, Hoffman M. Elevated prothrombin level and shortened clotting times in subjects with type 2 diabetes [13]. J. Thromb. Haemost. 2007;doi:10.1111/j15387836200702366. Ephraim RK, Awuku YA, Adu P, Ampomah LT, Adoba P, Panford S, et al. Ninnoni, J. P., & Agbodzakey H. High risk of coagulopathy among Type-2 Diabetes Mellitus clients at a municipal hospital in Ghana. Ghana Med. J. 2017;doi:10.4314/gmjv51i32. Lippi G, Franchini M, Targher G, Montagnana M, Salvagno G, Guidi G, et al. Epidemiological association between fasting plasma glucose and shortened APTT. Clin. Biochem . 2009; 42 (1–2):118–120. Bae S, Lee L, Roh K, Kim J. Platelet activation in patients with diabetic retinopathy. Korean J. Ophtamol. 2003; doi:10.3341/kjo200312140. Mard-Solta M, Dayer MR, Shamshirga A, Ali-Bahar H, Nasirbaghe Z. The Buffering Role of HDL in Balancing the Effects of Hypercoagulable State in Type 2 Diabetes. J. Appl. Sci. 2012;doi:10.3923/jas2012745752. American Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5-26. Badyal A, Bhatia AS. Reference range of glycated hemoglobin in the diagnosis of diabetes mellitus. Int J Res Med Sci. 2015;3(10):2669-2671. Lippi G, Targher G. Glycated hemoglobin (HbA1c): old dogmas, a new perspective? Clin Chem Lab Med . 2010;48(5):609-14. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4378442","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":302396188,"identity":"f0f24c70-840a-41d8-b78b-7a8f22c7395e","order_by":0,"name":"Samuel Antwi-Baffour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYPACCQYDBsYHH4AsOTCfB4gN8Gk4ANbCbDgDyDYmVgsDXEtiAyEt8v2Hnz3+2GbBYM5+mLHhY9u99A3nFzA+eNvGYLcdhxaDG2nmBgfbJBgse5IZG2e2FeduuPGA2XBuG0PyzgYcWiQYzCQObpOo33Ag//hj3rYEoJYDbNK8QC0GB3A57Pg3kBYGg/OPGZuBWtINbhxg/41PC8OBHDOIlhvJYC0JBucb2JiBWuxwaTG4kVMmcfYf0C8zHjM2zjiXYDjzBmOz5JxzEgl4HLZNouJMHYM5fzJjw4eyBHm+84cPfnhTZmOP02GYQAIcNRCSSMAPMd2eeB2jYBSMglEwzAEAgBphbZe7D/EAAAAASUVORK5CYII=","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Antwi-Baffour","suffix":""},{"id":302396189,"identity":"eaa9a958-bb50-4216-b6a6-8dd9bc4237c6","order_by":1,"name":"Benjamin Tetteh Mensah","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"Tetteh","lastName":"Mensah","suffix":""},{"id":302396190,"identity":"78913aa3-e856-4780-a8eb-632234352ddf","order_by":2,"name":"Dorinda Naa Okailey Armah","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Dorinda","middleName":"Naa Okailey","lastName":"Armah","suffix":""},{"id":302396191,"identity":"edcce601-8570-47b1-94ed-b2cfac1b8c38","order_by":3,"name":"Isaac Lartey Narh","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"Lartey","lastName":"Narh","suffix":""},{"id":302396192,"identity":"ffc98092-380c-476f-9c56-ba5d9b4a56e2","order_by":4,"name":"Lawrence Annison","email":"","orcid":"","institution":"Accra Technical University","correspondingAuthor":false,"prefix":"","firstName":"Lawrence","middleName":"","lastName":"Annison","suffix":""}],"badges":[],"createdAt":"2024-05-06 17:24:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4378442/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4378442/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62800459,"identity":"ef521744-42f5-4663-b333-1fe13d325ffd","added_by":"auto","created_at":"2024-08-19 15:50:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":581942,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4378442/v1/b55ea8dc-413e-4eae-95a8-df437135ec47.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Glycated Haemoglobin with Coagulation and Biochemical Profile of Patients with Type II Diabetes Mellitus","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDiabetes mellitus (DM) is a disease in which the body\u0026rsquo;s ability to produce or respond to insulin is impaired, leading to abnormal metabolism of carbohydrates and elevated levels of glucose in the blood [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Type 2 diabetes mellitus (T2DM) is particularly prevalent globally, with its incidence expected to rise significantly due to factors like obesity and metabolic syndrome [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The International Diabetes Federation estimated that in 2013, 382\u0026nbsp;million adults aged 20\u0026ndash;70 years worldwide had T2DM, with 80% of those affected living in low- and middle-income countries [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This number is expected to rise to 592\u0026nbsp;million by 2035 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Ghana, the prevalence is reported to be 6.3% and is expected to rise rapidly [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHyperglycemia, a hallmark of T2DM, triggers biochemical changes affecting protein, lipid, and carbohydrate metabolism [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Additionally, T2DM is a known risk factor for cardiovascular disorders, with approximately 80% of diabetic individuals facing the risk of thromboembolic cardiovascular disease [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, uncontrolled diabetes can lead to severe organ damage, termed microvascular and macrovascular complications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Regular monitoring and regulation of blood glucose levels play a critical role in enhancing the prognosis of diabetes. Glycated haemoglobin (HbA1c) is a valuable tool in this regard as it reflects average blood sugar levels over the preceding 2 to 3 months, offering a more comprehensive assessment compared to fasting blood glucose [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCoagulation abnormalities are common in T2DM, with increased clotting factors and reduced antithrombin III, protein C, and protein S levels contributing to hypercoagulability [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This condition accelerates atherosclerosis and elevates cardiovascular disease risk [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies indicate alterations in coagulation factors like fibrinogen, PT, APTT, INR, and D-dimer due to poor glycaemic control [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, comprehensive research on the coagulation balance in diabetes, especially in Sub-Saharan Africa, remains limited. Therefore, this study aims to explore the impact of poor glycemic control on coagulation and biochemical parameters in T2DM patients, filling crucial knowledge gaps in this field.\u003c/p\u003e"},{"header":"Methods","content":" \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAim, design and setting of the study.\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe study aimed to determine the effect of poor glycemic control on coagulation and biochemical parameters to reflect renal function status among patients with T2DM. The study was a cross-sectional one involving 150 recruited from the Diabetic Clinic of the Korle-Bu Teaching Hospital (KBTH). The study was conducted from January 2019 to December 2019.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eData Collection.\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSample/data collection procedure.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants completed a questionnaire for the collection of sociodemographic characteristics. Their heights and weights were then measured for the calculation of BMI. They then observed an overnight fast of 8 to 12 hours before their blood samples were collected for the fasting blood glucose (FBG) and HBA1c tests. Venous whole blood (8 ml) was taken, and 2 ml was placed into test-tubes containing sodium citrate as an anticoagulant; 2 ml was placed in EDTA tubes, 2 ml in SST tubes and 2 ml in fluoride tubes. The samples were sent to the Central Laboratory of the KBTH for analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSample analysis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eCoagulation parameter measurements.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe blood samples in citrate were centrifuged at a speed of 3000rpm for 15 minutes to obtain plasma which were dispensed into loading trays and run by the Automated Blood Coagulation Analyser CS-1600 produced by Sysmex West and Central Africa Ltd. This was done by placing the loaded trays into the loading chamber and the Analyser set to run. The results for APTT, PT, D-dimer, fibrinogen, and INR were obtained from this analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFasting blood glucose measurements.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFasting blood glucose concentrations were also measured on an automated Vitros chemistry analyser (Ortho Clinical Diagnostics, U.S.). Patient blood samples in fluoride oxalate tubes were centrifuged at 3000rpm for 2 minutes and the plasma poured into small sample cups, run and the results of each patient recorded. The participants\u0026rsquo; diabetes statuses were classified according to the following diagnostic criteria: Normal: FBG: 3.6\u0026ndash;6.0 mmol/l (65\u0026ndash;108 mg/dl). Diabetes fasting blood glucose: (FBG): \u0026ge;7.0 mmol/l (126 mg/dl).\u003c/p\u003e \u003cp\u003e \u003cb\u003eGlycated haemoglobin (HbA1c) determination.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe levels of HBA1c in the participants were also determined on the automated Vitros chemistry analyser. For each sample, blood samples in EDTA were poured into small sample cups and arranged on labelled sample trays according to the programme of the analyser. The sample trays were loaded on the analyser and run. After the run, the values of glycated haemoglobin for each patient were recorded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDetermination of selected biochemical parameters.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe biochemical parameters were also measured on the automated Vitros chemistry analyser. Here, participants\u0026rsquo; blood samples in the SST tube were centrifuged at 3000rpm for 5 minutes and serum obtained poured into small sample cups and run, after which the results of each patient were recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Data analysis\u003c/h2\u003e \u003cp\u003eThe data obtained were analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to analyse categorical and continuous variables. Student\u0026rsquo;s t test was employed to determine mean FBG differences among the two groups. The odds of diabetes among the populations were determined using unadjusted and adjusted logistic regression. A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was interpreted as significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic information of participants and controls\u003c/h2\u003e \u003cp\u003eThe participants were categorized into two groups based on their HbA1c levels: Group A (HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;6.5), denoting poor glycemic control, and Group B (HbA1c\u0026thinsp;\u0026lt;\u0026thinsp;6.5), denoting good glycemic control. Group A had an average age of 59.36 years, significantly higher than the average age of 50.83 years in Group B. Moreover, Group A had a higher proportion of females (73.3%) compared to males, while Group B had more males (80.0%) than females. Most participants in Group A belonged to the age group of 60\u0026ndash;80 years, whereas most participants in Group B were aged between 40\u0026ndash;60 years. In both groups, the highest proportion of participants were married and had basic education levels. Additionally, informal employment was more common in both groups, with 78.6% in Group A and 69.3% in Group B (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic information of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage age (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.36\u0026thinsp;\u0026plusmn;\u0026thinsp;13.475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.83\u0026thinsp;\u0026plusmn;\u0026thinsp;14.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (58.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (52.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eBiochemical profile of Participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eHBA1c was analysed to check for glycemic control. And as stated above, all the participants were placed in two groups of A and B according to their HBA1c results. Subsequently, all other biochemical parameters measured showed higher values in those in group A than those in group B, although the differences were not significant (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA table of the biochemical profiles of the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of analytes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026nbsp;value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (Q1\u0026ndash;Q3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (Q1\u0026ndash;Q3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.7 (6.5\u0026ndash;9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4 (4.6\u0026ndash;6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNa\u003csup\u003e+\u003c/sup\u003e\u0026nbsp;(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145.0 (138\u0026ndash;148)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141.5 (138.0\u0026ndash;144.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK\u003csup\u003e+\u003c/sup\u003e\u0026nbsp;(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.90 (4.00\u0026ndash;5.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.30 (3.93\u0026ndash;4.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCl\u003csup\u003e\u0026ndash;\u003c/sup\u003e\u0026nbsp;(mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105.5 (100\u0026ndash;110.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (100\u0026ndash;105)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUREA (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.1 (2.63\u0026ndash;9.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6 (2.4\u0026ndash;6.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCREAT (\u003cem\u003e\u0026micro;\u003c/em\u003emol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81.5 (64.25\u0026ndash;156.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.5 (57.25\u0026ndash;147.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCoagulation, biochemical and anthropometric profiles of the Participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the coagulation profile and anthropometric measurements of the participants. All coagulation parameters except fibrinogen showed significant differences (P\u0026thinsp;=\u0026thinsp;0.0001). The FBG results also showed a significant difference between the groups (p\u0026thinsp;=\u0026thinsp;0.0001). With the blood pressure measurement, SBP showed a significant difference between group A and group B. Although those in group A had average high DBP and BMI results compared with those in group B, the differences were not significant (p\u0026thinsp;=\u0026thinsp;0.294 and p\u0026thinsp;=\u0026thinsp;0.371, respectively) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA Table of Coagulation, Biochemical and Anthropometric Profiles of Participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e59.36\u0026thinsp;\u0026plusmn;\u0026thinsp;13.475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50.83\u0026thinsp;\u0026plusmn;\u0026thinsp;14.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.385\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.932\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.685\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e34.317\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0185\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.1662\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrinogen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-Dimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.532\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.350\u0026thinsp;\u0026plusmn;\u0026thinsp;7.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSBP (mmHg)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e147.29\u0026thinsp;\u0026plusmn;\u0026thinsp;32.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e119.76\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDBP (mmHg)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e81.18\u0026thinsp;\u0026plusmn;\u0026thinsp;19.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e77.40\u0026thinsp;\u0026plusmn;\u0026thinsp;11.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e21.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDiabetes is associated with cardiovascular issues like heart attacks, strokes, and peripheral arterial disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The precise causes of these problems are complex and not fully understood but involve abnormalities in blood clotting processes. Both arterial and venous clotting, previously thought to have distinct causes, are now understood to share similarities in their origins. Atherothrombosis, a type of clotting seen in diabetes, is likely due to the increased clotting tendency seen in diabetic patients. This suggests that diabetes creates a prothrombotic (blood clot-promoting) state, particularly in type 2 diabetes, which affects clot formation and dissolution processes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study aimed to investigate how blood sugar levels affect clotting and biochemical factors in type 2 diabetes patients. It examined 150 participants, dividing them into poorly controlled (A) and well-controlled (B) groups based on their HbA1c levels. Results showed that poorly controlled diabetes patients had shorter clotting times, lower INR levels, and higher fibrinogen and D-dimer levels, indicating a tendency towards excessive blood clotting. This suggests that poorly controlled type 2 diabetes patients are at a higher risk of thromboembolic events. These findings are consistent with other studies globally and in Ghana [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, some previous studies showed conflicting results regarding clotting factors in diabetes patients, possibly due to sample size and demographic differences [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGroup A, consisting of patients with poorly controlled diabetes, exhibited significantly higher FBG levels compared to Group B, which had better glycemic control. Moreover, Group A showed higher SBP values compared to Group B. Although average DBP and BMI were higher in Group A, these differences were not statistically significant. Additionally, levels of fibrinogen and D-dimer were elevated in Group A, while INR levels were decreased compared to Group B, supporting the prothrombotic episodes seen in poorly controlled diabetes. Furthermore, urea and creatinine levels were higher in Group A compared to Group B members, suggesting potential kidney function impairment associated with poorly controlled diabetes.\u003c/p\u003e \u003cp\u003eGlycated haemoglobin determination has been the gold standard for the evaluation of glycaemic control in diabetic patients for more than three decades [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this study, it was found that the HBA1c correlated with coagulation parameters such that those with high HBA1c (group A) showed a coagulation pattern that indicated hypercoagulability, while those (group B) with normal HBA1c values showed normal coagulation parameters and patterns. The differences were also significant.\u003c/p\u003e \u003cp\u003eFurthermore, all the other biochemical parameters measured to ascertain whether glycemia levels have any effect on renal function showed high values in those in group A compared with those in group B, although the differences were not significant. However, the lack of proper glycaemic control among the group A members may have an adverse effect on their kidneys. None of the participants was on anticoagulants. For limitations, risk factors such as increased LDL, smoking, obesity, physical activity, and unhealthy diet were not identified or accounted for among the participants.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study found that patients with poorly controlled diabetes had shorter clotting times and lower INR levels, indicating a tendency towards excessive blood clotting. Additionally, they had higher levels of fibrinogen and D-dimer, markers of blood clot formation and breakdown. These patients also showed elevated levels of FBG, blood pressure, and BMI. The study suggests that diabetes patients, especially those with poor control, are at increased risk of excessive blood clotting, leading to potential thrombotic events. Regular clotting tests may be necessary to identify and prevent cardiovascular complications in diabetes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"448\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;APTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;Activated partial prothrombin time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;Body mass index\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;CVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;Cardio-vascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eDBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eDiastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;Endothelial dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eEDTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eEthylenediaminetetraacetic acid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eFBG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eFasting blood glucose\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eHbA1c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eGlycated haemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eINR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eInternational normalize ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003e\u0026nbsp;KBTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eKorle-bu Teaching Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eLow density lipoprotein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eNIDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eNon-insulin dependent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eProthrombin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eStatistical package for social sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eT1DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eType 1 diabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.794642857142858%\"\u003e\n \u003cp\u003eT2DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.20535714285714%\" valign=\"bottom\"\u003e\n \u003cp\u003eType 2 diabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical\u0026nbsp;clearance was\u0026nbsp;obtained\u0026nbsp;from\u0026nbsp;the ethical\u0026nbsp;and protocol\u0026nbsp;review\u0026nbsp;committee\u0026nbsp;of\u0026nbsp;the College of Health Sciences (CHS-Et/M.1-P5.3/2018-2019) as\u0026nbsp;well\u0026nbsp;as\u0026nbsp;the institutional\u0026nbsp;ethical\u0026nbsp;committee of The Korle-Bu Teaching Hospital. All\u0026nbsp;the study details\u0026nbsp;were explained to the\u0026nbsp;participants,\u0026nbsp;and informed consent\u0026nbsp;was\u0026nbsp;obtained before the commencement of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author\u0026nbsp;upon\u0026nbsp;reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded using the University of Ghana book and research allowances of the research team members. The University of Ghana did not play any role\u0026nbsp;in\u0026nbsp;the design of the study; the\u0026nbsp;collection, analysis, and interpretation of data;\u0026nbsp;or the\u0026nbsp;writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSAB participated in the design, co-supervised the research, and drafted the manuscript. BTM participated in the design of the study, conducted experimental work, and proof reading of the manuscript. DNOA and \u0026nbsp;LA conducted the data analysis and editing of the manuscript. SAM and ILN participated in the supervision of the work and proof reading of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the directors and laboratory managers of the Central Laboratory at the\u0026nbsp;Korle-Bu Teaching Hospital.\u0026nbsp;Additionally, we thank\u0026nbsp;the staff and directors of the Diabetic Clinic of the Korle-Bu Teaching\u0026nbsp;Hospital\u0026nbsp;for their assistance in carrying out this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Diabetes Association; Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1. 2014;37(supplement _1); S81-S90. doi:10.2337/dc14s081.\u003c/li\u003e\n\u003cli\u003eGinter E, Simko V. Type 2 diabetes mellitus, pandemic in 21st century. Adv. Exp. Med. Biol. 2013;doi:10.1007/97814614544106.\u003c/li\u003e\n\u003cli\u003eDeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ et al. Type 2 diabetes mellitus. Nat. Rev. Dis. Primers. 2015; 1:15019. \u003c/li\u003e\n\u003cli\u003eTripodi A, Branchi A, Chantarangkul V, Clerici M, Merati G, Artoni A, et al. Hypercoagulability in patients with type 2 diabetes mellitus detected by a thrombin generation assay. J. Throm. Thrombolysis. 2011; doi:10.1007/s1123901005060.\u003c/li\u003e\n\u003cli\u003eHazari MAH, Ram Reddy, B, Uzma N, Santhosh Kumar B. Cognitive impairment in type 2 diabetes mellitus. Int. J. Diabetes Mellit. 2015;doi:10.1016/jijdm201101001.\u003c/li\u003e\n\u003cli\u003eAmoah AGB, Owusu SK, Adjei S. Diabetes in Ghana: A community based prevalence study in Greater Accra. Diabetes Res. Clin. Pract. 2002; doi:10.1016/s01688227(01)003746.\u003c/li\u003e\n\u003cli\u003eCoccheri S. Approaches to prevention of cardiovascular complications and events in diabetes mellitus. Drugs. 2007; doi:10.2165/0000349520076707000005.\u003c/li\u003e\n\u003cli\u003eMarchetti P, Cnop M, Eizirik DL. Prancreatic \u0026alpha; Cells are Resistant to MetabolicStress-Induced Apoptosis in Type 2 Diabetes. EBioMedicine. 2015;2:378-85.\u003c/li\u003e\n\u003cli\u003eWhiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Alas: Global Estimate of the Prevalence of Diabetes for 2011 and 2030. Diabetes Res. Clin. Pract. 2011;94:311-321. \u003c/li\u003e\n\u003cli\u003eRemkova A. (2006). Diagnostic approach to hypercoagulable states.\u003cstrong\u003e \u003c/strong\u003eBratisl. Lek. Listy. 2006;\u003cem\u003e107\u003c/em\u003e(8):292\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eCarr ME. Diabetes mellitus: A hypercoagulable state. J. Diabetes Complicat. 2001;doi:10.1016/s10568727(00)00132.\u003c/li\u003e\n\u003cli\u003eAsakawa H, Tokunaga K, Kawakami F. (2000). Elevation of fibrinogen and thrombin-antithrombin III complex levels of type 2 diabetes mellitus patients with retinopathy and nephropathy. J. Diabetes Complicat. 2000; doi:10.1016/s10568727(00)000751.\u003c/li\u003e\n\u003cli\u003eCeriello A. Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects. Diabetologia. 1993;36.\u003c/li\u003e\n\u003cli\u003eSauls DL, Banini AE, Boyd LC, Hoffman M. Elevated prothrombin level and shortened clotting times in subjects with type 2 diabetes [13]. \u003cem\u003eJ. Thromb. Haemost. \u003c/em\u003e2007;doi:10.1111/j15387836200702366.\u003c/li\u003e\n\u003cli\u003eEphraim RK, Awuku YA, Adu P, Ampomah LT, Adoba P, Panford S, et al. Ninnoni, J. P., \u0026amp; Agbodzakey H. High risk of coagulopathy among Type-2 Diabetes Mellitus clients at a municipal hospital in Ghana. Ghana Med. J. 2017;doi:10.4314/gmjv51i32.\u003c/li\u003e\n\u003cli\u003eLippi G, Franchini M, Targher G, Montagnana M, Salvagno G, Guidi G, et al. Epidemiological association between fasting plasma glucose and shortened APTT. Clin. Biochem\u003cstrong\u003e.\u003c/strong\u003e 2009;\u003cem\u003e42\u003c/em\u003e(1\u0026ndash;2):118\u0026ndash;120.\u003c/li\u003e\n\u003cli\u003eBae S, Lee L, Roh K, Kim J. Platelet activation in patients with diabetic retinopathy. Korean J. Ophtamol. 2003; doi:10.3341/kjo200312140.\u003c/li\u003e\n\u003cli\u003eMard-Solta M, Dayer MR, Shamshirga A, Ali-Bahar H, Nasirbaghe Z. The Buffering Role of HDL in Balancing the Effects of Hypercoagulable State in Type 2 Diabetes. J. Appl. Sci. 2012;doi:10.3923/jas2012745752.\u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5-26. \u003c/li\u003e\n\u003cli\u003eBadyal A, Bhatia AS. Reference range of glycated hemoglobin in the diagnosis of diabetes mellitus. Int J Res Med Sci. 2015;3(10):2669-2671.\u003c/li\u003e\n\u003cli\u003eLippi G, Targher G. Glycated hemoglobin (HbA1c): old dogmas, a new perspective? \u003cem\u003eClin Chem Lab Med\u003c/em\u003e. 2010;48(5):609-14.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hyperglycemia, Coagulation, Prothrombotic, Diabetes mellitus, Glycated Haemoglobin","lastPublishedDoi":"10.21203/rs.3.rs-4378442/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4378442/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003ePersistent hyperglycaemia in diabetes can lead to abnormal blood clotting due to the glycation of haemoglobin and other clotting proteins. Shortened activated partial thromboplastin time (APTT), prothrombin time (PT), altered levels of other clotting factors, and biochemical markers may indicate a higher risk of blood clot formation, which can contribute to vascular diseases and impact kidney function. This study examined 150 diabetic patients to analyse how their clotting and biochemical profiles were affected by glycemic control. Data on participants' demographics, socioeconomic status, and lifestyle were collected. Blood samples were analysed using automated coagulation and chemistry analysers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants were divided based on their glycated haemoglobin (HbA1c) levels with HbA1c\u0026thinsp;\u0026lt;\u0026thinsp;6.5 indicating good and HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;6.5 indicating poor glycemic control. Coagulation tests showed that patients with poorly controlled T2DM had shorter APTT and PT and decreased INR compared to those with good control. However, fibrinogen and D-dimer levels were elevated in all participants. While renal function markers were increased, the differences between the groups were insignificant. Furthermore, systolic blood pressure was significantly higher in poorly controlled T2DM patients. These findings suggest that individuals with poorly controlled T2DM may be more susceptible to thrombus formation due to increased activation of prothrombotic coagulation factors.\u003c/p\u003e","manuscriptTitle":"Comparison of Glycated Haemoglobin with Coagulation and Biochemical Profile of Patients with Type II Diabetes Mellitus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-15 17:53:22","doi":"10.21203/rs.3.rs-4378442/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"893bcee7-9132-41bc-a0f5-bafdbac8ace5","owner":[],"postedDate":"May 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-19T15:42:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-15 17:53:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4378442","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4378442","identity":"rs-4378442","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}