Changes in blood cell morphology associated with HBA1c levels in diabetes mellitus

Diabetes mellitus is a group of metabolic diseases characterized by impaired glucose utilization leading to chronic hyperglycemia. It is an endocrine disorder that presents severe clinical and public health problems worldwide, including in South Texas. Blood glucose levels are commonly used in the diagnosis of diabetes. Microvascular and macrovascular complications are common in patients with uncontrolled diabetes. However, HbA1c is a simple blood test that measures the average blood glucose levels over the past 2 to 3 months and is used to diagnose and effectively manage diabetes mellitus to prevent diabetic complications. In this study, we evaluated changes in red blood cell morphology with varying HbA1c levels in diabetic patients versus nondiabetic patients. Blood samples were collected from Driscoll and Shoreline Hospital labs in Corpus Christi, Texas. Sample collections are still ongoing at clinical sites. Peripheral blood smears were prepared from the unidentified patients’ blood samples and examined under the microscope for the number and kinds of cells present and other morphologic abnormalities. The collected blood samples were categorized based on HbA1c levels - group 1 (< 5.7% - nondiabetic); group 2 (5.7 - 6.4% - prediabetic); group 3 (>6.5% - diabetic) and by pediatric and adult groups. The pediatric control group indicated the highest number of ovalocytes (94%), anisocytosis (78%), and echinocytes (76%), the prediabetic group (80%, 90%, 60% respectively) and the diabetic group (83%, 83%, 67% respectively). The adult control group showed 53% ovalocytes, 58% anisocytosis, and 83% echinocytes, the prediabetic group showed 75%, 0%, 75% respectively, and the diabetic group showed 67%, 43%, 65% respectively. Surprisingly, the adults with the highest HbA1cs showed few morphological alterations. Overall, the numbers of anisocytosis, echinocytes, and ovalocytes in both pediatric and adult diabetic samples did not correlate with HbA1c levels, the observed few morphological changes may be attributable to the clinical care.