Assessment of Malaria Parasite Density in Asymptomatic Adult with Type 2 Diabetes

Abstract

Background: The importance of infection in the regulation of blood glucose is complex, but independent association of infectious agents such as plasmodia with increased glucose level through insulin resistance has been demonstrated in type 2 diabetes. The aim of this study was to evaluate malaria parasite density (MPD) of asymptomatic type 2 diabetes mellitus patients. Place and Duration of Study: Haematology unit and Diabetes Outpatient Clinic both of Enugu State University Teaching Hospital, between July and November 2024. Methodology: The study population consisted ofseventy (70) type 2 diabetes mellitus patients and thirty (30) apparently healthy subjects. Haemoglobin (HGB), packed cell volume (PCV) and red blood cell count (RBC) were measured by automated haematology analyzer, Erythrocyte sedimentation rate (ESR) bywestergren method, fasting blood glucose (FBG) by glucose oxidase method and thick and thin blood film were determined. Plasmodium parasites were counted against 200 white blood cells (WBCs) on the thick film. Malaria parasite densities (parasite/μl of whole blood) were then calculated as follows: (number of parasites counted/WBC counted) × WBC count per μl of blood. Results: Among the 70 type 2 diabetes mellitus patients, 53 had mild parasitemia (MPD< 2000 parasites/μl), 17 had moderate parasitemia (MPD: 2000 to < 10,000 parasites/μl) and none had severe parasitemia (MPD ≥ 10,000 parasites/μl). Malaria parasite density (1346.61 +/- 968.50 MPD/µL) and erythrocyte sedimentation rate (35.75+/- 22.82 mm/hr) were significantly higher in type 2 diabetes mellitus patients compared to apparently healthy control subjects (525.16 +/-  216.20 MPD/µL; 17.51 +/- 5.26 mm/hr) (P<0.05). Packed cell volume (36.88 +/- 6.62 %) were significantly lower in type 2 diabetes mellitus patients compared to apparently healthy control subjects (39.93 +/- 3.90 %) (p= 0.02). There was a significant negative correlation between malaria parasite density (MPD) and fasting blood glucose (P=0.035, r=0.253). Conclusion: This study found that in Enugu, Nigeria, type 2 diabetes mellitus patients had mild parasitaemia, decreased PCV and that MPD had significant correlation with fasting blood glucose. It is recommended that malaria parasite screening as well as counting of parasite densities be routinely done in diabetic patients as part of the measures to maintain a good glycemic control.