ORIGINAL ARTICLE

Study of neutrophil-lymphocyte ratio (NLR) in recent onset type 2 diabetes mellitus

Sharmila Dudani , Sanjiti Poodury, Sridhar Mangalesh

Sharmila Dudani
Department of Pathology, Army College of Medical Sciences, New Delhi, India. Email: [email protected]

Sanjiti Poodury
Department of Pathology, Army College of Medical Sciences, New Delhi, India

Sridhar Mangalesh
Department of Pathology, Army College of Medical Sciences, New Delhi, India
Online First: February 13, 2021 | Cite this Article
Dudani, S., Poodury, S., Mangalesh, S. 2021. Study of neutrophil-lymphocyte ratio (NLR) in recent onset type 2 diabetes mellitus. Bali Medical Journal 10(1): 11-16. DOI:10.15562/bmj.v10i1.1780


Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is increasing steadily, assuming an epidemic proportion throughout the world. Most of this increased burden will come from developing countries. Studies show an increasing role of inflammation in the pathophysiology of diabetes. Estimation of neutrophil-lymphocyte ratio (NLR) could be a simple, inexpensive marker to stratify at-risk diabetes patients. This study aimed to estimate the NLR and CRP levels as a measure of systemic inflammation in diabetics compared to healthy controls. We also investigated if NLR was lower in diabetics with good glycemic control. 

Methods: A cross-sectional comparative study, conducted in a tertiary hospital on 60 patients with T2DM and 69 healthy controls after voluntary informed consent. Anthropometric parameters, fasting plasma glucose, Lipid profile, CBC, CRP, and HbA1c were measured for all participants. 

Results: The diabetic group showed significantly higher waist circumference(p=0.007) mean TG (p=0.003), VLDL-c (p=0.001), LDL-c (p=0.010), TG/HDL-c (p=0.001), HbA1c (p=0.00001), MPV (p=0.002), NLR (p=0.006), and CRP (p=0.004) values and lower HDL-c values (p=0.039) as compared to the control group. No significant difference was seen in BMI, Waist -Hip ratio, total cholesterol, and total cholesterol/HDL-c values between the two groups. Among the diabetics, only HDL-c (p=0.018) and TG/HDL-c ratio (p=0.049) differed significantly with glycemic control.

Conclusion: Diabetics had higher inflammatory markers (NLR, CRP) as compared to controls. Dyslipidemia (high TG, low HDL-c with high TG/HDL-c) and a higher waist circumference were seen in diabetics. Diabetics with fair control of glycemia (HbA1c < 7%) did not demonstrate lower NLR levels indicating that meticulous glycemic control may not ameliorate the chronic inflammation seen in diabetics until dyslipidemia is corrected. 

References

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030.Diabetes Res Clin Pract 2010; 87:4-14. http://dx.doi.org/10.1016/j.diabres.2009.10.007

Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. AMJ 2014; 7: 45-48. http://dx.doi.org/10.4066/AMJ.2013.1979

Ruiz-Nunez B, Pruimboom L, Dijck –Brouwer DAJ, Muskiet FAJ. Lifestyle and nutritional imbalances associated with Western diseases: causes and consequences of chronic systemic low grade inflammation in an evolutionary context. The Journal of Nutritional Biochemistry 2013; 24: 1183-1201. http://dx.doi.org/10.1016/j.jnutbio.2013.02.009

Keane KN, Cruzat VF, Carlessi R, de Bittencourt PI, Newsholme PI. Molecular events linking oxidative stress and inflammation to insulin resistance and B-cell function. Oxid Med Cell Longev 2015;181643. http://dx.doi.org/10.1155/2015/181643.

Newsholme P, de Bittencourt PIH. The fat cell senescence hypothesis: a mechanism responsible for abrogating the resolution of inflammation in chronic disease. Current Opinion in Clinical Nutrition and metabolic care. 2014; 17:87-91. http://dx.doi.org/10.1097/mco.0000000000000077

de Rooij SR, Nijpels G, Nilsson PM et al. Low grade chronic inflammation in the relationship between insulin sensitivity with cardiovascular disease (RISC) population: association with insulin resistance and cardiometabolic risk profile. Diabetes Care 2009; 32: 1295-1301. http://dx.doi.org/10.2337/dc08-1795

Fernandez- Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 2003; 24: 278-301. http://dx.doi.org/10.1210/er.2002-0010

Coller BS. Leukocytosis and ischemic vascular disease morbidity and mortality: is it time to intervene? ArteriosclerThrombVascBiol; 2005; 25:658-670. http://dx.doi.org/10.1161/01.atv.0000156877.94472.a5

Hansson GK. Inflammation, atherosclerosis and coronary artery disease. N Engl J Med 2005; 352: 1685-1695. http://dx.doi.org/10.1056/nejmra043430

Huang W, Huang J, Liu Q, Lin F, He Z, Zeng Z et al. Neutrophil lymphocyte ratio is a relaible predictive marker for early stage diabetic nephropathy. Clin Endocrinol (Oxf) 2015; 82:229-33. http://dx.doi.org/10.1111/cen.12576

Lou M, Luo P, Tang R, Peng Y, Yu S, Huang W, et al. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocrine disorders 2015; 15:9. http://dx.doi.org/10.1186/s12902-015-0002-9

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; 42: 581-8. http://dx.doi.org/10.1177/0300060513516944

Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M et al. Association of neutrophil lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients’ with type 2 diabetes. Diabetes TechnolTher 2014; 16: 524-80. http://dx.doi.org/10.1089/dia.2013.0264

Fujita T, Hemmi S, Kajiwara M, Yabuki M, Fuke Y, Satomura A et al. Complement mediated chronic inflammation is associated with diabetic microvascular complications. Diabetes Metabolism Research Reviews 2013; 29: 220-226. http://dx.doi.org/10.1002/dmrr.2380

Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-53. https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539:AID-DIA668>3.0.CO;2-S

Pitsavos C, Tampourlou M, Panagiotakos DB, Skoumas Y, Chrysohoou C, Nomikos T et al. Association between low grade systemic inflammation and type 2 diabetes among men and women from the ATTICA study. Rev Diabet Stud 2007; 4: 98-104. https://doi.org/10.1900/rds.2007.4.98

Ackermann D, Jones J, Barona J, Calle MC, Kim JE, LaPia B, et al. Waist circumference is positively correlated with markers of inflammation and negatively with adiponectin in women with metabolic syndrome. Nutr Res 2011; 31: 197-204. https://doi.org/10.1016/j.nutres.2011.02.004

Lemieux I, Poiner P, Bergeron J, Almeras N, Lamarche B, Cantin B, et al. Hypertriglyceridemic waist : A useful screening phenotype in preventive cardiology ? Can J Cardiol 2007; 23 (Suppl B) 23B-31B. https://doi.org/10.1016/s0828-282x(07)71007-3

McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991; 337: 382-386. https://doi.org/10.1016/0140-6736(91)91164-p

Mahalle N, Garg MK, Naik SS, Kulkarni MV. Study of pattern of dyslipidemia and its correlation with cardiovascular risk factors in patients’ with coronary artery disease. Indian J Endocrinol Metab2014;18:48-55. https://doi.org/10.4103/2230-8210.126532

Mooradian AD. Dyslipidemia in type 2 DM. Nature Reviews Endocrinology 2009; 5: 150-9. https://doi.org/10.1038/ncpendmet1066

Stahlman M, Fagerberg B, Adiels M, Ekroos K, Chapman JM, Kontush A, et al. Dyslipidemia, but not hyperglycemia and insulin resistance, is associated with marked alterations in the HDL lipidome in type 2 diabetic subjects in the DIWA cohort: impact on small HDL particles. Biochim Biophys Acta. 2013; 183: 1609-17. https://doi.org/10.1016/j.bbalip.2013.07.009

Tsai JC, Sheu SH, Chiu HC, Chung FM, Chang DM, Chen MP et al. Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic vascular diseases in patients with type 2 diabetes mellitus. Diabetes Metabolism Research and Reviews 2007; 23: 111-118. https://doi.org/10.1002/dmrr.647

Welty FK. How do elevated triglycerides and low HDL-cholesterol affect inflammation and atherothrombosis. Curr Cardiol Rep 2013; 15:400. https://doi.org/10.1007/s11886-013-0400-4

Rodríguez- Carrio J, Alperi- López M, López P, López-Mejías R, Alonso- Castro S, Abal F et al. High triglycerides and low high density lipoprotein cholesterol lipid profile in rheumatoid arthritis: A potential link among inflammation, oxidative stress, and dysfunctional high-density lipoprotein. J Clin Lipidol 2017; 11: 1043-1052. https://doi.org/10.1016/j.jacl.2017.05.009


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