A Cytomorphometric and Cytopathological Evaluation of CervicoVaginal Smears (Pap Smears) in Patients with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is associated with chronic hyperglycemia, leading to immune dysfunction, increased susceptibility to infections and metabolic stress- induced cellular alterations. These factors may influence cervical epithelial morphology and contribute to the persistence of Human papillomavirus infection and progression of cervical lesions. Cytomorphometric analysis offers an objective method to detect subtle cellular changes in cervical smears. Aims and objectives: To comprehensively evaluate the cytological and cellular morphometric features of cervicovaginal smears (Pap smears) in women with T2DM. 1. To determine the prevalence of epithelial cell abnormalities as per the Bethesda System (2014) in Pap smears of diabetic women. 2. To identify and compare the spectrum and frequency of specific vaginal infections (e.g., Candidiasis, Bacterial Vaginosis, Trichomoniasis) and inflammatory patterns in diabetic group. 3. To perform a quantitative cytomorphometric analysis of normal-appearing intermediate squamous cells in poorly controlled and well-controlled diabetic populations as per latest American diabetes association (ADA) 2026 a. Nuclear Diameter (ND) b. Cytoplasmic Diameter (CD) c. Nuclear-to-Cytoplasmic (N:C) Ratio 4. To correlate cytopathological findings (presence of epithelial cell abnormalities, inflammation, and infection) with the degree of glycemic control as measured by Glycated Hemoglobin (HbA1c) levels within the diabetic group. 5. To correlate the cytomorphometric parameters (ND, CD, N:C ratio) with the HbA1c levels within the diabetic group. 6. To investigate any association between the age of the patient, the diabetes, and the observed cytological changes. Materials and Methods: This cross-sectional study was conducted at a tertiary care center in CHRI,Tamilnadu and included women. Cervical- vaginal smears were collected using conventional Pap smear technique and reported according to Bethesda system (2014). Cytomorphometric parameters namely CD, ND and N:C ratio, were measured using Image J software. Glycemic indices including fasting blood sugar (FBS), Postprandial blood sugar (PPBS) and HbA1c were documented. Data analysis was carried out using SPSS version 25, with ANOVA and t-tests; p -value of less than 0.05 was considered statically significant. Results: The study population demonstrated poor glycemic control (mean HbA1C: 8.49%) as per ADA 2026. Even though majority of cases were tested negative for intraepithelial lesion, significant number of epithelial abnormalities were observed including ASCUS (4.3%), LSIL (0.7%) and HSIL (2.9%). Infective conditions were present in 16.7% of cases, with Candida being the most common. Cytomorphometric analysis revealed increased nuclear diameter and a higher N:C ratio in patients with poor glycemic control. A statistically significant association was found between elevated HbA1c levels and increased N:C ratio(p=0.002). Additionally, N:C ratio showed significant variation across cytological categories (p <0.001), increasing with severity of epithelial abnormalities. Conclusion: Inadequate glycemic control in patients with Type 2 diabetes mellitus is significantly associated with cytomorphometric alterations in cervical squamous epithelial cells, characterised by nuclear enlargement, cytoplasmic reduction and increased N:C ratio. These changes may represent early indicators of epithelial atypia and increased susceptibility to cervical dysplasia. Increase in HbA1c is associated with squamous intraepithelial lesion. Incorporating cytomorphometric analysis into routine Pap smear screening may enhance early detection of epithelial abnormalities, particularly in high-risk diabetic patients. Strict glycemic control may play a role in maintaining cervical epithelial integrity and reducing disease progression.