Retrospective analysis of the relationship between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and glycemic regulation in patients with type 2 diabetes mellitus followed up at an internal medicine outpatient clinic

Inflammatory markers in type 2 diabetes

Authors

Keywords:

neutrophil lymphocyte ratio, platelet lymphocyte ratio, type 2 diabetes mellitus

Abstract

Background/Aim: Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increasing incidence worldwide and its effects are being seen in many countries. Insulin resistance is the main factor in the pathophysiology. T2DM leads to an increase in mortality and morbidity due to macrovascular and microvascular complications. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are effective parameters in monitoring the inflammatory response. The primary aim of this study was to investigate glycemic control in patients with type 2 diabetes by focusing on their correlation with inflammatory markers, such as NLR and PLR, glycated hemoglobin (HbA1c), and fasting blood glucose levels.

Methods: The present study was carried out in 2022 within the purview of the Internal Medicine Clinic at Balikesir İvrindi State Hospital. Data from the initial annual consultations of patients with T2DM, either newly diagnosed or previously diagnosed and visiting for follow-up, were utilized. Our study excluded patients under the age of 18 and those diagnosed with cirrhosis, heart failure, type 1 diabetes mellitus, malignancy, epilepsy, acute infection, pregnancy, or chronic inflammatory disease. We further excluded those on medications including steroids, antivirals, anticonvulsants, antipsychotics, antithyroids, and chemotherapeutic drugs that impact the leukocyte count. Based on their HbA1c levels, patients were systematically categorized into two distinct cohorts: those with controlled blood sugar (HbA1c ≤7%) and those with uncontrolled blood sugar (HbA1c >7%). In the ambit of this study, we incorporated data from 205 patients. We employed a cross-sectional study that retrospectively examined the correlation between NLR, PLR, and glycemic regulation in T2DM patients. SPSS 22.0 software was used to perform statistical calculations.

Results: It was observed that patients with poor glycemic control had longer disease durations and this disparity bore statistical significance (P=0.005). Patients exhibiting poor glycemic control demonstrated elevated levels of CRP (C-reactive protein), a difference that reached statistical significance (P=0.003). The group exhibiting poor glycemic control demonstrated a notable elevation in NLR, indicating statistical significance (P=0.001). Although it was not statistically significant, PLR was found to be higher in patients with uncontrolled T2DM (P=0.441).

Conclusion: This research investigates the correlation between HbA1c levels and inflammatory markers, specifically NLR and TLR, in T2DM patients who exhibit poor control of glycemia. Our findings highlight the potential of these markers as indicators of glycemic control, thus emphasizing the need for integrated strategies for managing inflammation and improving glycemic control in T2DM patients. The novelty of this area of research contributes to the scarcity of available literature, underlining the importance and timeliness of this study. Based on our findings, we suggest an increased focus on regular monitoring of inflammatory markers, for instance NLR and PLR, to assess the glycemic control in T2DM patients. The significant correlation of these markers with HbA1c levels implies that they could potentially serve as useful tools in personalizing diabetes management strategies, leading to improved patient outcomes. Not only does our research contribute to filling this knowledge gap, but it also underscores the potential for utilizing inflammatory markers in tracking disease progression and optimizing treatment efficacy in T2DM.

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References

Tinajero MG, Malik VS. An Update on the Epidemiology of Type 2 Diabetes: A Global Perspective. Endocrinol Metab Clin North Am. 2021 Sep;50(3):337-55. doi: 10.1016/j.ecl.2021.05.013. DOI: https://doi.org/10.1016/j.ecl.2021.05.013

Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017 Jun;128:40-50. doi: 10.1016/j.diabres.2017.03.024. DOI: https://doi.org/10.1016/j.diabres.2017.03.024

Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018 Feb;14(2):88-98. doi: 10.1038/nrendo.2017.151. DOI: https://doi.org/10.1038/nrendo.2017.151

Wang X, Bao W, Liu J, Ouyang YY, Wang D, Rong S, et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2013 Jan;36(1):166-75. doi: 10.2337/dc12-0702. DOI: https://doi.org/10.2337/dc12-0702

Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol. 2014 Sep;33(3):223-7. doi: 10.3109/15569527.2013.834498. DOI: https://doi.org/10.3109/15569527.2013.834498

Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018 Feb;52:131-6. doi: 10.1016/j.clinbiochem.2017.11.008. DOI: https://doi.org/10.1016/j.clinbiochem.2017.11.008

Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014 May 29;106(6):dju124. doi: 10.1093/jnci/dju124. DOI: https://doi.org/10.1093/jnci/dju124

Khandare SA, Chittawar S, Nahar N, Dubey TN, Qureshi Z. Study of Neutrophil-lymphocyte Ratio as Novel Marker for Diabetic Nephropathy in Type 2 Diabetes. Indian J Endocrinol Metab. 2017 May-Jun;21(3):387-92. doi: 10.4103/ijem.IJEM_476_16. DOI: https://doi.org/10.4103/ijem.IJEM_476_16

Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, Savli H. Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci. 2019 Mar;19(1):1602-6. doi: 10.4314/ahs.v19i1.35. DOI: https://doi.org/10.4314/ahs.v19i1.35

El-Gazzar AG, Kamel MH, Elbahnasy OKM, El-Naggar ME. Prognostic value of platelet and neutrophil to lymphocyte ratio in COPD patients. Expert Rev Respir Med. 2020 Jan;14(1):111-6. doi: 10.1080/17476348.2019.1675517. DOI: https://doi.org/10.1080/17476348.2019.1675517

Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019 Jul;39(4):345-57. doi: 10.3343/alm.2019.39.4.345. DOI: https://doi.org/10.3343/alm.2019.39.4.345

Abdallah A., Abdelaziz A., El-Sayed E., Emran T. Study of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as a predictor inflammatory marker for diabetic nephropathy in type 2 diabetic patients. The Egyptian Journal of Hospital Medicine, 72(7), 4800-7. doi: 10.21608/ejhm.2018.10137 DOI: https://doi.org/10.21608/ejhm.2018.10137

Atak B, Aktas G, Duman TT, Erkus E, Kocak MZ, Savli H. Diabetes control could through platelet-to-lymphocyte ratio in hemograms. Rev Assoc Med. 2019 Jan;65(1):38-42. doi: 10.1590/1806-9282.65.1.38 DOI: https://doi.org/10.1590/1806-9282.65.1.38

Rohm TV, Meier DT, Olefsky JM, Donath MY. Inflammation in obesity, diabetes, and related disorders. Immunity. 2022 Jan 11;55(1):31-55. doi: 10.1016/j.immuni.2021.12.013. DOI: https://doi.org/10.1016/j.immuni.2021.12.013

Cho Y, Lee SY. Useful Biomarkers of Metabolic Syndrome. Int J Environ Res Public Health. 2022 Nov 15;19(22):15003. doi: 10.3390/ijerph192215003. DOI: https://doi.org/10.3390/ijerph192215003

Dolapoğlu N, Yürekli BPŞ, Eker MÇ, Elbi H. Relationship Between Serum Agouti-Related Peptide Levels and Metabolic Syndrome in Euthymic Bipolar Patients. Noro Psikiyatr Ars. 2020 Oct 11;58(1):16-20. doi: 10.29399/npa.25005. DOI: https://doi.org/10.29399/npa.25005

Liu C, Feng X, Li Q, Wang Y, Li Q, Hua M. Adiponectin, TNF-α and inflammatory cytokines and risk of type 2 diabetes: A systematic review and meta-analysis. Cytokine. 2016 Oct;86:100-9. doi: 10.1016/j.cyto.2016.06.028. DOI: https://doi.org/10.1016/j.cyto.2016.06.028

Goyal R, Jialal I. Diabetes Mellitus Type 2. 2022 Jun 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30020625.

ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. On behalf of the American Diabetes Association. 6. Glycemic Targets: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S97-S110. doi: 10.2337/dc23-S006. DOI: https://doi.org/10.2337/dc23-S006

Hartz A, Kent S, James P, Xu Y, Kelly M, Daly J. Factors that influence improvement for patients with poorly controlled type 2 diabetes. Diabetes Res Clin Pract. 2006 Dec;74(3):227-32. doi: 10.1016/j.diabres.2006.03.023. DOI: https://doi.org/10.1016/j.diabres.2006.03.023

Al-Eitan LN, Nassar AM, Saadeh NA, Almomani BA. Evaluation of Glycemic Control, Lifestyle and Clinical Characteristics in Patients with Type 2 Diabetes Treated at King Abdullah University Hospital in Jordan. Can J Diabetes. 2016 Dec;40(6):496-502. doi: 10.1016/j.jcjd.2016.04.009. DOI: https://doi.org/10.1016/j.jcjd.2016.04.009

Al-Ma'aitah OH, Demant D, Jakimowicz S, Perry L. Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis. J Adv Nurs. 2022 Aug;78(8):2257-76. doi: 10.1111/jan.15255. DOI: https://doi.org/10.1111/jan.15255

Luc K, Schramm-Luc A, Guzik TJ, Mikolajczyk TP. Oxidative stress and inflammatory markers in prediabetes and diabetes. J Physiol Pharmacol. 2019 Dec;70(6). doi: 10.26402/jpp.2019.6.01.

Khan HA, Sobki SH, Khan SA. Association between glycaemic control and serum lipids profile in type 2 diabetic patients: HbA1c predicts dyslipidaemia. Clin Exp Med. 2007 Mar;7(1):24-9. doi: 10.1007/s10238-007-0121-3. DOI: https://doi.org/10.1007/s10238-007-0121-3

Al Quran TM, Bataineh ZA, Al-Mistarehi AH, Zein Alaabdin AM, Allan H, Al Qura'an A, et al. Prevalence and Pattern of Dyslipidemia and Its Associated Factors Among Patients with Type 2 Diabetes Mellitus in Jordan: A Cross-Sectional Study. Int J Gen Med. 2022 Oct 4;15:7669-83. doi: 10.2147/IJGM.S377463. DOI: https://doi.org/10.2147/IJGM.S377463

Bilgin S, Aktas G, Zahid KM, Atak BM, Kurtkulagi O, Duman TT, Savli H. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. Aging Male. 2020 Dec;23(5):923-7. doi: 10.1080/13685538.2019.1632283. DOI: https://doi.org/10.1080/13685538.2019.1632283

Sefil F, Ulutas KT, Dokuyucu R, Sumbul AT, Yengil E, Yagiz AE, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res. 2014 Apr;42(2):581-8. doi: 10.1177/0300060513516944. DOI: https://doi.org/10.1177/0300060513516944

Chang FY, Shaio MF. Decreased cell-mediated immunity in patients with non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1995 May;28(2):137-46. doi: 10.1016/0168-8227(95)00168-8. DOI: https://doi.org/10.1016/0168-8227(95)00168-8

Tong PC, Lee KF, So WY, Ng MH, Chan WB, Lo MK, et al. White blood cell count is associated with macro- and microvascular complications in Chinese patients with type 2 diabetes. Diabetes Care. 2004 Jan;27(1):216-22. doi: 10.2337/diacare.27.1.216. DOI: https://doi.org/10.2337/diacare.27.1.216

Buyukkaya E, Karakas MF, Karakas E, Akçay AB, Tanboga IH, Kurt M, et al. Correlation of neutrophil to lymphocyte ratio with the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost. 2014 Mar;20(2):159-63. doi: 10.1177/1076029612459675. DOI: https://doi.org/10.1177/1076029612459675

Akinsegun A, Akinola OD, Sarah JO, Olajumoke O, Adewumi A, Majeed O, et al. Mean platelet volume and platelet counts in type 2 diabetes: mellitus on treatment and non-diabetic mellitus controls in Lagos, Nigeria. Pan Afr Med J. 2014 May 12;18:42. doi: 10.11604/pamj.2014.18.42.3651. DOI: https://doi.org/10.11604/pamj.2014.18.42.3651

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2023-07-13

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1.
Kula AC. Retrospective analysis of the relationship between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and glycemic regulation in patients with type 2 diabetes mellitus followed up at an internal medicine outpatient clinic: Inflammatory markers in type 2 diabetes. J Surg Med [Internet]. 2023 Jul. 13 [cited 2024 Apr. 19];7(7):404-8. Available from: https://jsurgmed.com/article/view/7795