Research Article
The relationship between neutrophil lymphocyte ratio and diabetes control in patients with type 2 diabetes mellitus
Abstract
Purpose
The current study was to investigate the association of NLR and the control of glucose. We also aimed to reveal correlations between Mean Platelet Volume (MPV), Red blood cell distribution (RDW), microalbuminuria and glycosylated hemoglobin (HbA1c).
Methods
This study was a retrospective study conducted in Ege University Faculty of Medicine Endocrinology Department. We obtained the medical records of 198 patients with type 2 diabetes mellitus and they were divided into two groups; patients with controlled diabetes mellitus (Hba1c≤7 %) (n=82) and patients with uncontrolled diabetes mellitus (Hba1c>7 %) (n=116)
Results
There were no significant differences in NLR, RDW and MPV in two groups (p=0.123 vs. p=0.298, p=0.595 respectively). Duration of diabetes mellitus 5 years and below and after 5 years between two groups was statistically significant (p=0.002). NLR was found higher in uncontrolled DM than controlled DM, but not statistically significant. Receiver operating characteristic curve analysis of NLR, RDW, MPV, WBC were found not statistically significant (p>0.05).
Conclusion
Elevations of WBC levels may be related with diabetes control. Duration of diabetes mellitus may predict microalbuminuria. Our study revealed that duration of diabetes mellitus may predict microalbuminuria, and the present study evaluated the relationship between NLR, RDW, MPV and Hba1c, microalbuminuria together in the patients with T2DM.
Keywords
Neutrophil Lymphocyte Ratio type 2 Diabetes Mellitus White Blood Cell Count microalbuminuria
References
- Tabish SA. Is Diabetes Becoming the Biggest Epidemic of the Twenty-first Century? Int J Health Sci (Qassim) 2007; 1: V-VIII.
- Association AD. Standards of medical care in diabetes--2010. Diabetes Care 2010; 33 Suppl 1: S11-61.
- Wang X, Bao W, Liu J, et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2013; 36: 166-75.
- Kamata K, Mizukami H, Inaba W, et al. Islet amyloid with macrophage migration correlates with augmented β-cell deficits in type 2 diabetic patients. Amyloid 2014; 21: 191-201.
- Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest 2017; 127: 1-4.
- Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012; 5: 2.
- Gomez D, Farid S, Malik HZ, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg 2008; 32: 1757-62.
- Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 2009; 16: 614-22.
- Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009; 58: 15-23.
- Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102: 653-7.
- Wu CC, Sytwu HK, Lin YF. Cytokines in diabetic nephropathy. Adv Clin Chem 2012; 56: 55-74.
- Okyay GU, Inal S, Oneç K, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 2013; 35: 29-36.
- 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; 19: 1602-6.
- Wei N, Zheng H, Nathan DM. Empirically establishing blood glucose targets to achieve HbA1c goals. Diabetes Care 2014; 37: 1048-51.
- Pitsavos C, Tampourlou M, Panagiotakos DB, et al. Association Between Low-Grade Systemic Inflammation and Type 2 Diabetes Mellitus Among Men and Women from the ATTICA Study. Rev Diabet Stud 2007; 4: 98-104.
- Fröhlich M, Imhof A, Berg G, et al. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000; 23: 1835-9.
- Festa A, D'Agostino R, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42-7.
- Öztürk ZA, Kuyumcu ME, Yesil Y, et al. Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients? J Endocrinol Invest 2013; 36: 593-9.
- Jaaban M, Zetoune AB, Hesenow S, Hessenow R. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as novel risk markers for diabetic nephropathy in patients with type 2 diabetes. Heliyon 2021; 7: e07564.
- Huang W, Huang J, Liu Q, et al. Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy. Clin Endocrinol (Oxf) 2015; 82: 229-33.
- Tong PC, Lee KF, So WY, et al. White blood cell count is associated with macro- and microvascular complications in chinese patients with type 2 diabetes. Diabetes Care 2004; 27: 216-22.
- Klein NJ, Shennan GI, Heyderman RS, Levin M. Alteration in glycosaminoglycan metabolism and surface charge on human umbilical vein endothelial cells induced by cytokines, endotoxin and neutrophils. J Cell Sci 1992; 102 ( Pt 4): 821-32.
- Baud L, Ardaillou R. Tumor necrosis factor alpha in glomerular injury. Kidney Int Suppl 1994; 45: S32-6.
- Shanmugam N, Reddy MA, Guha M, Natarajan R. High glucose-induced expression of proinflammatory cytokine and chemokine genes in monocytic cells. Diabetes 2003; 52: 1256-64.
- Vallance P, Collier J, Bhagat K. Infection, inflammation, and infarction: does acute endothelial dysfunction provide a link? Lancet 1997; 349: 1391-2.
- Vozarova B, Weyer C, Lindsay RS, Pratley RE, Bogardus C, Tataranni PA. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002; 51: 455-61.
- Ohshita K, Yamane K, Hanafusa M, et al. Elevated white blood cell count in subjects with impaired glucose tolerance. Diabetes Care 2004; 27: 491-6.
- Sefil F, Ulutas KT, Dokuyucu R, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res 2014; 42: 581-8.
- Wang SY, Shen TT, Xi BL, Shen Z, Zhang X. Vitamin D affects the neutrophil-to-lymphocyte ratio in patients with type 2 diabetes mellitus. J Diabetes Investig 2021; 12: 254-65.
- Chen Y, Chai Q, Wang Q, et al. Neutrophil-to-lymphocyte ratio is associated with coronary microvascular dysfunction in type 2 diabetes mellitus patients. Diabetes Res Clin Pract 2021; 178: 108983.
- Sari I, Sunbul M, Mammadov C, et al. Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiol Pol 2015; 73: 1310-6.
- Fawwad A, Butt AM, Siddiqui IA, Khalid M, Sabir R, Basit A. Neutrophil-to-lymphocyte ratio and microvascular complications in subjects with type 2 diabetes: Pakistan’s perspective. Turk J Med Sci 2018; 48: 157-61.
- Bilgin S, Aktas G, Zahid Kocak M, et al. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. Aging Male 2020; 23: 923-7.
- Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R. Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal 2020; 34: e23259.
- Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005; 352: 1011-23.
- Yoon HE, Kim SJ, Hwang HS, Chung S, Yang CW, Shin SJ. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients. PLoS One 2015; 10: e0126272.
- Atalay H, Boyuk B, Ates M, Guzel S, Celebi A, Ekizoglu I. Red cell distribution width and acute complications of diabetes. Acta Endocrinol (Buchar) 2018; 14: 514-9.
- Lippi G, Targher G, Salvagno GL, Guidi GC. Increased red blood cell distribution width (RDW) is associated with higher glycosylated hemoglobin (HbA1c) in the elderly. Clin Lab 2014; 60: 2095-8.
- Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7: 157-61.
- Saigo K, Yasunaga M, Ryo R, Yamaguchi N. [Mean platelet volume in diabetics]. Rinsho Byori 1992; 40: 215-7.
- Papanas N, Symeonidis G, Maltezos E, et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2004; 15: 475-8.
- Ünübol M, Ayhan M, Güney E. The relationship between mean platelet volume with microalbuminuria and glycemic control in patients with type II diabetes mellitus. Platelets 2012; 23: 475-80.
Year 2022,
, 444 - 451, 12.09.2022
Abstract
Amaç
Diabetik hastalarda Nötrofil lenfosit oranı ve glikoz kontrolü arasındaki ilişkiyi araştırmayı amaçladık. Ortalama Trombosit Hacmi (MPV), Kırmızı kan hücre dağılımı (RDW), mikroalbüminüri ve glikozile hemoglobin (HbA1c) arasındaki korelasyonları ortaya koymayı amaçladık.
Yöntem
Bu çalışma Ege Üniversitesi Tıp Fakültesi Endokrinoloji Anabilim Dalı'nda gerçekleştirilen retrospektif bir çalışmadır. Tip 2 diabetes mellituslu 198 hastanın tıbbi kayıtlarını aldık ve bunlar iki gruba ayrıldı; Kontrollü diabetes mellituslu hastalar (Hba1c≤%7) (n=82) ve kontrolsüz diabetes mellituslu hastalar (Hba1c>%7) (n=116)
Sonuçlar
NLR, RDW ve MPV'de iki grupta anlamlı fark yoktu (sırasıyla p=0,123'e karşı p=0,298, p=0,595). İki grup arasında 5 yıl ve altı ve 5 yıl üstü diabetes mellitus süresi istatistiksel olarak anlamlıydı (p=0,002). NLR, kontrolsüz DM'de kontrollü DM'den daha yüksek bulundu, ancak istatistiksel olarak anlamlı değildi. NLR, RDW, MPV, WBC'nin ROC eğrisi analizi istatistiksel olarak anlamlı bulunmadı (p>0.05).
Sonuç
WBC seviyelerindeki yükselmeler diyabet kontrolü ile ilişkili olabilir. Diabetes mellitusun süresi mikroalbüminüriyi öngörebilir. Çalışmamız diyabetes mellitus süresinin mikroalbüminüriyi öngörebileceğini oarta çıkardı ve çalışmamızda T2DM'li hastalarda NLR, RDW, MPV ve Hba1c, mikroalbüminüri arasındaki ilişkiyi değerlendirdik.
References
- Tabish SA. Is Diabetes Becoming the Biggest Epidemic of the Twenty-first Century? Int J Health Sci (Qassim) 2007; 1: V-VIII.
- Association AD. Standards of medical care in diabetes--2010. Diabetes Care 2010; 33 Suppl 1: S11-61.
- Wang X, Bao W, Liu J, et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2013; 36: 166-75.
- Kamata K, Mizukami H, Inaba W, et al. Islet amyloid with macrophage migration correlates with augmented β-cell deficits in type 2 diabetic patients. Amyloid 2014; 21: 191-201.
- Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest 2017; 127: 1-4.
- Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012; 5: 2.
- Gomez D, Farid S, Malik HZ, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg 2008; 32: 1757-62.
- Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 2009; 16: 614-22.
- Cho H, Hur HW, Kim SW, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009; 58: 15-23.
- Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102: 653-7.
- Wu CC, Sytwu HK, Lin YF. Cytokines in diabetic nephropathy. Adv Clin Chem 2012; 56: 55-74.
- Okyay GU, Inal S, Oneç K, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 2013; 35: 29-36.
- 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; 19: 1602-6.
- Wei N, Zheng H, Nathan DM. Empirically establishing blood glucose targets to achieve HbA1c goals. Diabetes Care 2014; 37: 1048-51.
- Pitsavos C, Tampourlou M, Panagiotakos DB, et al. Association Between Low-Grade Systemic Inflammation and Type 2 Diabetes Mellitus Among Men and Women from the ATTICA Study. Rev Diabet Stud 2007; 4: 98-104.
- Fröhlich M, Imhof A, Berg G, et al. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000; 23: 1835-9.
- Festa A, D'Agostino R, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102: 42-7.
- Öztürk ZA, Kuyumcu ME, Yesil Y, et al. Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients? J Endocrinol Invest 2013; 36: 593-9.
- Jaaban M, Zetoune AB, Hesenow S, Hessenow R. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as novel risk markers for diabetic nephropathy in patients with type 2 diabetes. Heliyon 2021; 7: e07564.
- Huang W, Huang J, Liu Q, et al. Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy. Clin Endocrinol (Oxf) 2015; 82: 229-33.
- Tong PC, Lee KF, So WY, et al. White blood cell count is associated with macro- and microvascular complications in chinese patients with type 2 diabetes. Diabetes Care 2004; 27: 216-22.
- Klein NJ, Shennan GI, Heyderman RS, Levin M. Alteration in glycosaminoglycan metabolism and surface charge on human umbilical vein endothelial cells induced by cytokines, endotoxin and neutrophils. J Cell Sci 1992; 102 ( Pt 4): 821-32.
- Baud L, Ardaillou R. Tumor necrosis factor alpha in glomerular injury. Kidney Int Suppl 1994; 45: S32-6.
- Shanmugam N, Reddy MA, Guha M, Natarajan R. High glucose-induced expression of proinflammatory cytokine and chemokine genes in monocytic cells. Diabetes 2003; 52: 1256-64.
- Vallance P, Collier J, Bhagat K. Infection, inflammation, and infarction: does acute endothelial dysfunction provide a link? Lancet 1997; 349: 1391-2.
- Vozarova B, Weyer C, Lindsay RS, Pratley RE, Bogardus C, Tataranni PA. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002; 51: 455-61.
- Ohshita K, Yamane K, Hanafusa M, et al. Elevated white blood cell count in subjects with impaired glucose tolerance. Diabetes Care 2004; 27: 491-6.
- Sefil F, Ulutas KT, Dokuyucu R, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res 2014; 42: 581-8.
- Wang SY, Shen TT, Xi BL, Shen Z, Zhang X. Vitamin D affects the neutrophil-to-lymphocyte ratio in patients with type 2 diabetes mellitus. J Diabetes Investig 2021; 12: 254-65.
- Chen Y, Chai Q, Wang Q, et al. Neutrophil-to-lymphocyte ratio is associated with coronary microvascular dysfunction in type 2 diabetes mellitus patients. Diabetes Res Clin Pract 2021; 178: 108983.
- Sari I, Sunbul M, Mammadov C, et al. Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiol Pol 2015; 73: 1310-6.
- Fawwad A, Butt AM, Siddiqui IA, Khalid M, Sabir R, Basit A. Neutrophil-to-lymphocyte ratio and microvascular complications in subjects with type 2 diabetes: Pakistan’s perspective. Turk J Med Sci 2018; 48: 157-61.
- Bilgin S, Aktas G, Zahid Kocak M, et al. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. Aging Male 2020; 23: 923-7.
- Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R. Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal 2020; 34: e23259.
- Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005; 352: 1011-23.
- Yoon HE, Kim SJ, Hwang HS, Chung S, Yang CW, Shin SJ. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients. PLoS One 2015; 10: e0126272.
- Atalay H, Boyuk B, Ates M, Guzel S, Celebi A, Ekizoglu I. Red cell distribution width and acute complications of diabetes. Acta Endocrinol (Buchar) 2018; 14: 514-9.
- Lippi G, Targher G, Salvagno GL, Guidi GC. Increased red blood cell distribution width (RDW) is associated with higher glycosylated hemoglobin (HbA1c) in the elderly. Clin Lab 2014; 60: 2095-8.
- Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7: 157-61.
- Saigo K, Yasunaga M, Ryo R, Yamaguchi N. [Mean platelet volume in diabetics]. Rinsho Byori 1992; 40: 215-7.
- Papanas N, Symeonidis G, Maltezos E, et al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2004; 15: 475-8.
- Ünübol M, Ayhan M, Güney E. The relationship between mean platelet volume with microalbuminuria and glycemic control in patients with type II diabetes mellitus. Platelets 2012; 23: 475-80.
There are 42 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 12, 2022 |
| Submission Date | June 8, 2022 |
| Published in Issue | Year 2022 |