A CROSS SECTIONAL STUDY OF ANTIPHOSPHOLIPID ANTIBODY LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN ENUGU, SOUTH-EAST NIGERIA

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A CROSS SECTIONAL STUDY OF ANTIPHOSPHOLIPID ANTIBODY LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN ENUGU, SOUTH-EAST NIGERIA

Abstract

BACKGROUND: Antiphospholipid antibodies (APLS) are group of acquired, heterogeneous, autoimmune antibodies that bind to phospholipid(s), phospholipid – binding proteins or both. Antiphospholipid antibodies are associated with thrombosis (arterial, venous or both). Type 2 – diabetes mellitus is the commonest type of diabetes mellitus, characterised by hyper-glycaemia due to relative insulin deficiency or insulin resistance, or both. Type 2 – diabetes mellitus predisposes to arterial thrombosis, with wide range of ischaemic thrombosis, with the manifestation of TIA and stroke, nephropathy, retinopathy, neuropathy, platelet abnormalities, hypertension and other complications.
OBJECTIVE: To detect and assess the prevalence of antiphospholipid antibodies in subjects with type 2 diabetes mellitus. METHODOGY: This was a cross –sectional study carried out on subjects with T2DM attending the diabetic clinic of University of Nigeria Teaching Hospital (UNTH), Ituku – Ozalla, Enugu, South – East Nigeria. The healthy control subjects were recruited from consented blood donors, in the blood transfusion unit of Department of Haematology and Immunology of UNTH; medical students and hospital (UNTH) workers. Ethical clearance was obtained from the ethical committee of UNTH. Two hundred and ten (210) subjects were recruited for this study. They were grouped into three (complicated T2DM, uncomplicated T2DM and healthy control) and, each had 70 subjects, matched for sex and age between complicated T2DM and uncomplicated T2DM. The Lupus anticoagulant (LA) was assayed using commercially Dilute Russell’s Viper Venom Time (DRVVT) reagent for the screening and confirmatory tests, manufactured by Technoclone GmbH, Austria, Vienna. The IgG –β2GP1 – dependent – Anticardiolipin antibody (ACA), was assayed using ELISA test kit (Anticardiolipin 1gG ELISA kit GWB – 521211, by GenWay Bio-tech, San Diego, USA). The other laboratory tests done apart from LA and IgG-β2GP1-dependent-ACA, included platelet count using Haematology Analyser-Mythic 22; glycated haemoglobin 1C (HbA1C) using the D-10TM Haemoglobin Testing System Analyser. RESULTS: The Lupus anticoagulant (LA) showed a prevalence of 7.1% in complicated T2DM, 4.3% in uncomplicated T2DM and healthy control subjects respectively, while prevalence of IgG-β2GP1-ACA was 4.3% in all the groups. Analysis of Variance (ANOVA), showed significant statistical difference in the mean platelet count for complicated T2DM 208.5(52.30) and healthy control subjects 277.5(23.90), (F=77.993, P<0.001). There was significant difference in mean glycated haemoglobin 1C (HbA1C) between complicated T2DM and healthy control subjects (p<0.001, 95% CI: -3.0 to -2.1) and in uncomplicated T2DM and healthy control subjects (p<0.001, 95% CI:-2.8 to 2.0), using Post Hoc statistical analysis. Pearsons statistical analysis, showed significant correlation for APLS and platelet count in complicated T2DM subjects (r=0.316, P=0.008).

CONCLUSION Lupus anticogulants (LA) were found in both subjects and controls, but the prevalence was significantly higher than in controls, only in subjects with complicated T2DM. Anticardiolipin antibodies were found and were equally prevalent in both T2DM subjects and in normal controls.HbA1C levels were found to be significantly higher in subject with complicated T2DM. Significantly lower platelet counts were found in subjects with complicated and uncomplicated T2DM , compared to normal controls. There was no significant correlation found between prevalent of LA or ACA and platelet counts in T2DM. However, there was significant correlation between HbA1C levels and platelet counts in both complicated and uncomplicated T2DM. There was no significant association between LA or ACA prevalence and occurrence of vascular or other complications in T2DM. In view of the findings in this study, presence of antiphospholipid antibodies may not caused by, or directly related to the T2DM, and cannot be regarded as a complication of T2DM. RECOMMENDATION In addition to the usual biochemical tests, regular evaluation of HbA1C levels and platelet counts should be done in the routine monitoring of patients with T2DM. Since APLS may be associated with vascular thrombosis, as may T2DM. However, regular evaluation of APLS may not be required in the management, or routine monitoring of patients with T2DM. Although, there is no causal or significant statistical association of APLS and the risk of T2DM patients developing thrombosis was observed in this study, there is need for multicentre robust studies to evaluate the relationship of APLS and thrombosis in persons with complicated T2DM in our environment.

A CROSS SECTIONAL STUDY OF ANTIPHOSPHOLIPID ANTIBODY LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN ENUGU, SOUTH-EAST NIGERIA

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