Assessment of Demographic, Hematological, and Biochemical Profiles in Type-2 Diabetes Mellitus Patients of the Garhwal Region, Uttarakhand

Type-2 Diabetes Mellitus (T2DM) is a chronic, progressive metabolic disorder primarily characterized by persistent hyperglycemia due to insulin resistance and/or insulin deficiency. According to the International Diabetes Federation (IDF) Diabetes Atlas 2023 (10th Edition), approximately 537 million adults (aged 20–79 years) were living with diabetes globally in 2021¹. This number is projected to rise to 643 million by 2030 and 783 million by 2045, largely due to urbanization, aging populations, sedentary lifestyles, and unhealthy diets. Notably, over 75% of diabetics reside in low- and middle-income countries, where diagnostic access and ongoing care are often insufficient².

In India, the burden is particularly severe. Based on findings from the ICMR–INDIAB Study Phase II (2023) and the National Family Health Survey, Fifth Round (NFHS-5, 2022), more than 101 million Indian adults are living with diabetes, while another 136 million are categorized as prediabetic. A recent publication in The Lancet Diabetes & Endocrinology (2023) highlighted that early-onset T2DM is rapidly rising in the 20–40 years age group, with urban-rural differences diminishing. Previously considered an urban lifestyle disease, diabetes is now a growing challenge in rural and hilly regions, including Himalayan states like Uttarakhand, due to transitions in food patterns, physical inactivity, and minimal access to routine screenings³.

In the Garhwal region of Uttarakhand, districts such as Pauri, Chamoli, Rudraprayag, and Tehri are witnessing a steady increase in T2DM prevalence. Factors like rural-to-urban migration, dietary westernization, declining physical labor, and low awareness have compounded the issue. However, region-specific clinical and epidemiological data from this high-altitude population remains limited and underreported⁴.

T2DM not only impairs glucose metabolism but is also associated with multiple hematological and biochemical alterations that act as early markers of systemic complications. Hematological changes commonly seen include anemia (Hb <12 g/dL), reduced RBC counts, elevated total leukocyte count (TLC), and increased erythrocyte sedimentation rate (ESR), indicating chronic inflammation, oxidative stress, and potential infection risk⁵.

Biochemically, uncontrolled T2DM typically manifests as elevated fasting blood glucose (FBG) and HbA1c (>6.5%), alongside dyslipidemia—characterized by high triglycerides (TG), low high-density lipoprotein (HDL), and elevated low-density lipoprotein (LDL). These lipid alterations significantly heighten the risk of atherosclerosis, coronary artery disease, and cerebrovascular events. Moreover, renal biomarkers such as serum creatinine and urea frequently show early impairment due to evolving diabetic nephropathy⁶.

Recent studies support this clinical pattern. A community study in rural Himachal Pradesh (2022) showed that nearly 68.4% of diabetic patients exhibited at least one deranged hematological or renal marker. Similarly, a district-level study from Chamoli, Uttarakhand (2023) reported over 70% of T2DM patients with coexisting lipid abnormalities and early nephropathy signs. At the national scale, a multicentric study published in Diabetes Research and Clinical Practice (2024) found that three out of five diabetics across India had coexisting anemia, dyslipidemia, or early kidney dysfunction, emphasizing the need for integrated monitoring⁷.

Institutional research from the region echoes this trend. A retrospective analysis conducted at AIIMS Rishikesh (2019–2020) on over 500 diabetic and prediabetic individuals revealed significantly raised HbA1c (7.2–10.8%), serum triglycerides, and LDL, along with early signs of renal dysfunction. In addition, the Department of Biochemistry, HNB Garhwal University, presented preliminary PhD findings in 2023, showing that 68% of T2DM patients from Pauri and Chamoli districts had hemoglobin <12 g/dL, serum creatinine >1.3 mg/dL, and total cholesterol >200 mg/dL, pointing toward a high burden of anemia and dyslipidemia in this population⁸.

This study aims to bridge this knowledge gap by assessing and correlating hematological and biochemical markers among T2DM patients residing in the Garhwal region. The objective is to identify early systemic changes, estimate complication risks, and provide a foundation for region-specific diagnostic, preventive, and management protocols.

Need of the Study

This study is essential to assess the profile of T2DM patients in the Garhwal region of Uttarakhand, as region-specific clinical and epidemiological data for this high-altitude population remains limited and underreported.

The primary needs addressed are:

• Bridging the Knowledge Gap: T2DM is associated with multiple hematological and biochemical alterations (such as anemia, dyslipidemia, and renal dysfunction) that act as early markers of systemic complications. The study aims to fill the gap in local data regarding the prevalence of these markers.
• Identifying Early Complications: The objective is to identify early systemic changes and estimate complication risks by assessing and correlating these markers.
• Foundation for Management: The findings are necessary to provide a foundation for region-specific diagnostic, preventive, and management protocols.
• Generating Clinical Insights: The study aims to generate region-specific clinical insights for better T2DM management in this population.

Aim and Objectives

Aim: To assess the demographic, hematological, and biochemical profiles of T2DM patients in the Garhwal region to identify early complications and support region-specific diabetes management.

Objectives:

1. To assess demographic characteristics of T2DM patients.
2. To evaluate hematological parameters (Hb, RBC, TLC, ESR).
3. To assess biochemical markers (FBG, HbA1c, lipid profile, urea, creatinine).
4. To determine the prevalence of anemia, dyslipidemia, and renal dysfunction.
5. To correlate HbA1c with hematological and biochemical alterations.
6. To generate region-specific clinical insights for better T2DM management.

METHODOLOGY

1. Study Design:

This is a cross-sectional, observational study designed to assess the demographic, hematological, and biochemical profiles of Type 2 Diabetes Mellitus (T2DM) patients in the Garhwal region.

2. Study Site:

The study will be conducted at the following healthcare facilities in the Pokhra block of Pauri Garhwal district, Uttarakhand:

• Outpatient Department (OPD) of the Rural Health Training Centre (RHTC)
• Community Health Centre (CHC)
• Government hospitals in the Pokhra block.

3. Study Duration:

The study will be conducted over a period of 6 months (e.g., July to December 2025).

4. Study Criteria:

Inclusion Criteria:

• Patients diagnosed with Type 2 Diabetes Mellitus (T2DM).
• Age between 30 to 75 years.
• Both males and females.
• Patients who provide written informed consent.
• Residents of Garhwal region, specifically the Pokhra block.

Exclusion Criteria:

• Patients with Type 1 Diabetes Mellitus.
• Patients with known hematological disorders (e.g., thalassemia, leukemia).
• Pregnant or lactating women.
• Patients with acute infections or chronic liver diseases.
• Individuals unwilling to provide consent.

5. Source of Data:

• Patient records from OPD registers of RHTC, CHC, and government hospitals.
• Direct interviews using a pre-structured questionnaire.
• Laboratory reports of hematological and biochemical investigations.

6. Data Collection:

Data will be collected through:

• Patient interviews for demographic details (age, gender, lifestyle, etc.).
• Clinical history and physical examination.
• Blood sample analysis for:
  • Hematological parameters: Hb, RBC, TLC, ESR
  • Biochemical markers: FBG, HbA1c, lipid profile, urea, creatinine

7. Study Procedure:

• T2DM patients visiting the selected healthcare centers will be screened for eligibility.
• After obtaining informed consent, demographic and clinical data will be recorded.
• Venous blood samples will be collected following standard aseptic procedures.
• Samples will be sent to authorized clinical laboratories for analysis.
• Reports will be collected and data compiled using a case record form (CRF).

8. Data Analysis:

Data was analyzed by preparing tables and graphs using Microsoft excel.

RESULTS

To assess demographic characteristics of T2DM patients

The study was conducted among 80 Type-2 Diabetes Mellitus (T2DM) patients in the Rural Health Training Centre (RHTC), Community Health Center (CHC), and OPD of the government hospital in the Pokhra block of Pauri Garhwal district. Under demographic assessment, all subjects were evaluated to obtain the following results.

Gender wise distribution of T2DM patients

The study population showed a higher prevalence of Type 2 Diabetes Mellitus (T2DM) in males (57.5%) compared to females (42.5%). (Table 1 and Figure 1)

Table 1: Gender wise distribution of T2DM patients

Figure 1: Gender wise distribution of T2DM patients

Age wise distribution of T2DM patients

The majority of the T2DM patients in the study belonged to the 51 – 60 years age group, accounting for 35% of the total. The next largest group was those over 60 years (30%). (Table 2 and Figure 2)

Table 2: Age wise distribution of T2DM patients

Figure 2: Age wise distribution of T2DM patients

BMI wise distribution of T2DM patients

A significant portion of the patients were classified as obese (≥30) at 47.5%, followed by the overweight category (35%). This highlights a high burden of obesity within this diabetic population. (Table 3 and Figure 3)

Table 3: BMI wise distribution of T2DM patients

Figure 3: BMI wise distribution of T2DM patients

Duration wise distribution of T2DM patients

The largest group of patients, 40%, were those with a relatively recent diagnosis of T2DM, having the condition for less than 5 years. Patients with a duration of 5–10 years accounted for 37.5%.  (Table 4 and Figure 4)

Table 4: Duration wise distribution of T2DM patients

Figure 4:  Duration wise distribution of T2DM patients

To Evaluate Hematological Parameters (Hb, RBC, TLC, ESR).

Anemia (low hemoglobin) was highly prevalent, affecting 52.5% of the patients, with a mean Hb level of 11.8±2.1 g/dl. Additionally, a large proportion (45%) showed signs of chronic inflammation, indicated by a raised Erythrocyte Sedimentation Rate (ESR) (32±8.6 mm/hr). (Table 5 and Figure 5)

Table 5: Hematological findings of study population

Figure 5:  Prevalence of Hematological Abnormalities

To assess biochemical markers (FBG, HbA1c, lipid profile, urea, creatinine).

The biochemical profile indicated severe control issues and co-morbidities:

• Glycemic Control: HbA1c was raised in 90% of patients (mean 8.4±1.9), and Fasting Blood Glucose (FBG) was raised in 82.5% (mean 158±45 mg/dl), pointing to poor long-term glucose management.
• Dyslipidemia: High levels of Triglycerides (65% abnormal) and Total Cholesterol (60% abnormal) were common. Critically, the protective HDL cholesterol was low in 62.5% of patients.
• Renal Function: Signs of early kidney impairment were noted, with Serum Urea raised in 22.5% and Creatinine raised in 20% of patients. (Table 6 and Figure 6)

Table 6: Biochemical profile of study population

Figure 6:  Prevalence of Biochemical Abnormalities

To determine the prevalence of anemia, dyslipidemia, and renal dysfunction

Dyslipidemia was the most frequent complication, affecting 67.5% of the T2DM patients. Anemia was present in 52.5%, and Renal Dysfunction was observed in 25% of the cohort. (Table 7 and Figure 7)

Table 7: Frequency of complications among T2DM Patients

Figure 7:  Frequency of complications among T2DM Patients