• Hisham Arif Alrawi College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.




Type 2 diabetes mellitus, Red blood cell indices, Red blood cell count, Glycosylated haemoglobin



Type 2 diabetes mellitus (T2DM) accounts for more than 90% of all diagnosed cases of diabetes. Earlier reports described an independent association of haematological indices, such as red blood cells (RBCs), haemoglobin (Hb), hematocrit (Hct), mean corpuscular haemoglobin (MCV), platelet count (Plt), and white blood cell count (WBC) with the risk of occurrence of T2DM.


To evaluate the relationship between T2DM and red cell indices.

Patients and Methods

The current cross-sectional study recruited 400 patients with T2DM who were referred to the Diabetic Center in Sulaimani city, Northern Iraq, from November 2018 to March 2019 and 200 healthy blood donors who donated from March to April 2019 to the Sulaimani Blood Bank Center. The required data were collected from both groups, and relevant haematological tests and biochemical analyses were performed. 


Anemia was found in 8% of the patients giving higher rates among the females. Normocytic anaemia was observed in (82.8%) of the patients. Half of the patients had a high level of RBC counts, which correlates significantly with high HbA1c (p=0.005). The prevalence of pre-diabetic and diabetes was 15.5% among healthy blood donors. Patients with T2DM and donation experience showed lower HbA1c levels than those without blood donation (p<0.05). 


Normocytic anaemia is the most common type in patients with T2DM. Patients with a high level of RBC count might be worth screening for T2DM. A high frequency of pre-diabetic and diabetic among asymptomatic healthy blood donors was observed.


Antwi-Balfour S, Hammond S, Adjei JK, Kyeremeh R, Martin-Odoom A, Ekem I. A case-control study of the prevalence of anaemia among patients with type 2 diabetes. J Med Case Rep. 2016; 10 (1): 110. DOI: https://doi.org/10.1186/s13256-016-0889-4

Cho YI, M.P Mooney, DJ Cho. Hemorheological disorders in diabetes mellitus. J diabetes sci technol. 2008; 2(6):1130-1138. DOI: https://doi.org/10.1177/193229680800200622

Marini MA, Fiorentino TV, Andreozzi F, Mannino GC, Perticone M, Sciacqua A, et al. Elevated 1-h post-challenge plasma glucose levels in subjects with standard glucose tolerance or impaired glucose tolerance are associated with whole blood viscosity. Acta Diabetol. 2017; 54(8): 775-784. DOI: https://doi.org/10.1007/s00592-017-1004-z

Marini MA, Fiorentino TV, Andreozzi F, Mannino GC, Succurro E, Sciacqua A, et al. Hemorheological alterations in adults with prediabetes identified by haemoglobin A1c levels. Nutr Metab Cardiovasc Dis. 2017; 27(7): 601-608. DOI: https://doi.org/10.1016/j.numecd.2017.04.001

Lachin JM, Genuth S, Nathan DM, Zinman B, Rutledge BN; DCCT/EDIC Research Group. Effect of glycemic exposure on the risk of microvascular complications in the diabetes control and complications trial--revisited. Diabetes. 2008; 57(4): 995-1001. DOI: https://doi.org/10.2337/db07-1618

Fadini GP, Morin M, Facco M, Bonamico S, Baesso I, Grego F, et al. Circulating endothelial progenitor cells are reduced in peripheral vascular complications of type 2 diabetes mellitus. J Am Coll Cardiol. 2005; 45(9): 1449-1457. DOI: https://doi.org/10.1016/j.jacc.2004.11.067

Wang ZS, Song ZC, Bai JH, Li F, Wu T, Qi J, et al. Red blood cell count as an indicator of microvascular complications in Chinese patients with type 2 diabetes mellitus. Vasc Health Risk Manag. 2013; 9: 237-43. DOI: https://doi.org/10.2147/VHRM.S43211

Milosevic D, Panin VL. Relationship between Hematological Parameters and Glycemic Control in Type 2 Diabetes Mellitus Patients. J Med Biochem. 2019; 38(2): 164-171.

Vozarova B, Weyer C, Lindsay RS, Pratley RE, Bogardus C, Tataranni PA. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes. 2002; 51(2): 455-461. DOI: https://doi.org/10.2337/diabetes.51.2.455

Tong PC, Lee KF, So WY, Ng MH, Chan WB, Lo MK, et al. White blood cell count is associated with macro-and microvascular complications in Chinese patients with type 2 diabetes. Diabetes Care. 2004; 27(1): 216-222. DOI: https://doi.org/10.2337/diacare.27.1.216

Deng Y, Papageorgiou DP, Li X, Perakakis N, Mantzoros CS, Dao M, et al. Quantifying Fibrinogen-Dependent Aggregation of Red Blood Cells in Type 2 Diabetes Mellitus. Biophys J. 2020; 119(5): 900-912. DOI: https://doi.org/10.1016/j.bpj.2020.07.026

Nguyen QM, Xu J-H, Chen W, Srinivasan SR, Berenson GS. Correlates of age onset of type 2 diabetes among relatively young black and white adults in a community. Diabetes Care. 2012; 35:1341-1346. DOI: https://doi.org/10.2337/dc11-1818

Harrigan N. Risk Factors for Type 2 Diabetes. US Pharm. 2007; 32(10): 61-63.

Akter S, Rahman MM, Krull Abe S, Sultana P. Prevalence of diabetes and prediabetes and their risk factors among Bangladeshi adults: a nationwide survey. Bulletin of the World Health Organization 2014; 92: 204-213A. DOI: https://doi.org/10.2471/BLT.13.128371

Florkowski C. HbA1c as a Diagnostic Test for Diabetes Mellitus - Reviewing the Evidence. ClinBiochem Rev. 2013; 34(2): 75-83.

Bonakdaran S, Gharebaghi M, Vahedian M. Prevalence of anaemia in type-2 diabetes and renal involvement. Saudi J Kidney Dis Transpl. 2011; 22: 286-290.

Yang J, Yan PJ, Wan Q, Li H. Association between haemoglobin levels and diabetic peripheral neuropathy in patients with type 2 diabetes: a cross-sectional study using electronic health records J. Diabetes Res. 2017; p. 2835981. DOI: https://doi.org/10.1155/2017/2835981

Idris I, Tohid H, Muhammad NA, A Rashid MR, Mohd Ahad A, Ali N, et al. Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study. BMJ Open. 2018; 8(12): e025125. DOI: https://doi.org/10.1136/bmjopen-2018-025125

Harita N, Hayashi T, Sato KK, Nakamura Y, Yoneda T, Endo G, et al. Lower serum creatinine is a new risk factor of type 2 diabetes: the Kansai healthcare study. Diabetes Care. 2009; 32(3): 424-426. DOI: https://doi.org/10.2337/dc08-1265

Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM. Association of high serum creatinine and anaemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol. 2003; 14(11): 2919-2925. DOI: https://doi.org/10.1097/01.ASN.0000092138.65211.71

Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001; 345(11): 790-797. DOI: https://doi.org/10.1056/NEJMoa010492

Malena M, Prnjavorac B, Bego T, Dujic T, Semiz S, Skrbo S, et al. Effect of Cigarette Smoking on Haematological Parameters in Healthy Population. Med. Arch. 2017; 71: 132-136. DOI: https://doi.org/10.5455/medarh.2017.71.132-136

WHO Blood Safety Indicators, 2007. Geneva: World Health Organization; 2009.

Li Q, Li L, Li Y. Enhanced RBC aggregation in type 2 diabetes patients. Journal of Clinical Laboratory Analysis. 2015; 29: 387–389. DOI: https://doi.org/10.1002/jcla.21784

Jaman S, Rahman S, Rubaiya SRR, Mahato J, Miah MM, Ayshasiddeka M, et al. Diabetes and red blood cell parameters. Ann Clin Endocrinol Metabol. 2018; 2:1-9. DOI: https://doi.org/10.29328/journal.acem.1001004

Sheikhpour R, Sadeghian F, Rajabi S. Correlation between glycated haemoglobin, serum glucose and serum lipid levels in type 2 diabetes. Iranian Journal of Diabetes and Obesity. 2013; 5(1): 12-15.

Tamariz LJ, Young JH, Pankow JS, Yeh HC, Schmidt MI, Astor B, et al. Blood viscosity and hematocrit as risk factors for type 2 diabetes mellitus: the atherosclerosis risk in communities (ARIC) study. Am J Epidemiol. 2008; 168(10): 1153-1160. DOI: https://doi.org/10.1093/aje/kwn243

Milosevic D, Panin VL. Relationship between Hematological Parameters and Glycemic Control in Type 2 Diabetes Mellitus Patients. J Med Biochem. 2019; 38(2):164-171. DOI: https://doi.org/10.2478/jomb-2018-0021

Bigna JJ, Nansseu JR, Katte JC, Noubiap JJ. Prevalence of prediabetes and diabetes mellitus among adults residing in Cameroon: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018; 137: 109-118. DOI: https://doi.org/10.1016/j.diabres.2017.12.005

Mirahmadizadeh A, Fathalipour M, Mokhtari AM, Zeighami S, Hassanipour S, Heiran A. et al. The prevalence of undiagnosed type 2 diabetes and prediabetes in Eastern Mediterranean Region (EMRO): A systematic review and meta-analysis. Diabetes Res Clin Pract. 2020; 160: 107931. DOI: https://doi.org/10.1016/j.diabres.2019.107931

Huang Z, Liu Y, Mao Y, Chen W, Xiao Z, Yu Y. Relationship between glycated haemoglobin concentration and erythrocyte survival in type 2 diabetes mellitus determined by a modified carbon monoxide breath test. J Breath Res. J Breath Res. 2017; 12(2): 026004. DOI: https://doi.org/10.1088/1752-7163/aa9081



How to Cite

Alrawi H. EVALUATION OF RED BLOOD CELL INDICES IN TYPE 2 DIABETES MELLITUS IN SULAYMANIYAH CITY, KURDISTAN REGION, IRAQ. JSMC [Internet]. 2022 Jun. 21 [cited 2024 Jul. 15];12(2):197-206. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10361

Similar Articles

1-10 of 233

You may also start an advanced similarity search for this article.