title: Red blood cell distribution width and diabetes-associated complications.
abstract: OBJECTIVE
  Red blood cell distribution width (RDW) is a marker of cardiovascular morbidity and mortality. However, there is little data on the relationship between RDW and diabetes-associated complications. The aim was to investigate whether there is any association between RDW, nephropathy, neuropathy and peripheral arterial disease (PAD) in a type 2 diabetic population.
  
  
  METHODS
  This study included 196 diabetic patients with proliferative diabetic retinopathy. All subjects were investigated for diabetic nephropathy, diabetic neuropathy and PAD. Participants underwent 24-h blood pressure monitoring and were analysed for markers of the metabolic syndrome, inflammation, and insulin resistance.
  
  
  RESULTS
  57% of the participants had diabetic nephropathy, 46% had diabetic neuropathy while 26% had PAD. No significant association was found between RDW, diabetic neuropathy and PAD (p=NS). However, RDW was strongly associated with diabetic nephropathy (p=0.006), even following adjustment for potential confounding variables. Multivariate logistic regression analysis showed RDW (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.15-2.35, p=0.006), estimated glomerular filtration rate (OR 0.98, 95% CI 0.96-0.99, p<0.001), night-time diastolic blood pressure (OR 1.07, 95% CI 1.03-1.11, p=0.001) and erythrocyte sedimentation rate (OR 1.03, 95% CI 1.004-1.05, p=0.019) to be independently associated with diabetic nephropathy.
  
  
  CONCLUSIONS
  This is the first study to report lack of association between RDW, neuropathy and PAD in subjects with type 2 diabetes mellitus. More importantly, RDW was shown to be significantly associated with diabetic nephropathy in a type 2 diabetic population with advanced proliferative retinopathy independent of traditional risk factors, including diabetes duration and glycaemic control.
authors.affiliation: Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida, Malta; Department of Medicine, University of Malta Medical School, Tal-Qroqq, Malta. Electronic address: cjmagri013@yahoo.com.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Magri
authors.affiliation: Diabetes & Endocrine Centre, Mater Dei Hospital, Tal-Qroqq, Msida, Malta; Department of Medicine, University of Malta Medical School, Tal-Qroqq, Malta.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fava
mesh_terms: D015415:Biomarkers / Q000097:blood; D015924:Blood Pressure Monitors; D048909:Diabetes Complications / Q000097:blood / Q000473:pathology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000473:pathology*; D004906:Erythrocyte Count / Q000706:statistics & numerical data; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D016015:Logistic Models; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000097:blood / Q000473:pathology*
chemical_list: D015415:Biomarkers
keywords: Diabetes mellitus; Nephropathy; Neuropathy; Peripheral arterial disease; Red blood cell distribution width