Association of Neutrophil to Lymphocyte and Platelet To Lymphocyteratio with Blood Glucose Regulation in Type 2 Diabetes Patients
Diabetes is characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and lipid metabolism. Disorders of lipid metabolism are common in diabetes causing greater cardiovascular risks. Leukocytosis is a major marker of metabolic syndrome. Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are related to subclinical inflammation worsening the glycemic control. HbA1c is used as a marker of blood glucose regulation.
To investigate the association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with blood glucose regulation in patients with type 2 diabetes mellitus.
This comparative analytical study was conducted in Shifa International Hospital on diabetic patients. Sample size was calculated as 62 by WHO sample size calculator . Non randomized convenient sampling was used. Patients were divided into two groups according to HbA1c level taking 7% as cut off point. Full blood count, lipid profile and liver profile were carried out. Data was analyzed by SPSS version 21. Descriptive statistics were calculated for categorical variables. For quantitative normal and dispersed variables, independent student t and Mann Whitney U test were applied respectively. P Value less than 0.05 was considered significant.
Out of total 93 patients,33 (35.4 %) were males and 60(64.5%) were females. The mean duration of disease was 8.26 ± 5.8 years. NLR and PLR were elevated in patients having poor glucose control but that difference was not significant. Significant difference between the groups was found with random blood glucose. LDL, triglycerides , cholesterol ratio, ALT and AST were raised in patients having poor glycemic control.
Patients having poor blood glucose regulation have increased levels of haematological and serological parameters posing greater cardiovascular health risks to patients with type 2 diabetes
2.Maumus S, Marie B, Siest G, Visvikis-Siest S. A prospective study on prevalence of metabolic syndrome among French families. Diabetes Care.2005; 28(3):675-82.
3. Goldstein DE, Little RR , Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care.1995; 18:896-909.
4. Hammoud T, Tanguay JF, Bourassa MG. Management of coronary artery disease: therapeutic options in patients with diabetes. J Am CollCardiol . 36, 2000,355-65
5. Little RR. Recent progress in glycohaemogloboin (HbA1c) Testing. Diabetes Care.2000; 23:265-266
6. Selvin E, Coresh J, Golden SH, Brancati FL, Folsom AR, Steffes MW. Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study. Arch Intern Med.2005; 165:1910-1916.
7. Rofling CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE. Defining the relationship between plasma glucose and HbA1c:analysis of glucose profile and HbA1c in the Diabetes Control and Complications Trial. Diabetes Care.2002; 25:275-278.
8. Mertoglu C, Guany M.NLR and PLR as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr.2017; 11(1):127-31.
9. Sefil F, Ulutas KT, Dokuyucu R, Sumbul AT, Yengil R, et al. Investigation of NLR and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res.2014; 42(2):581-88.
10. Hussain M, Saeed M, Majeed MZ, Atif MA, Akhtar L. Nebivolol attenuates neutrophil lymphocyte ratio: A marker of subclinical inflammation in hypertensive patients. Int J Hypertens.2017; 2017 (6):7643682.
11.Lou M, Lou P, He L, Tang R, Peng Y, Yu S, Huang W. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus. BMC Endocr Discord.2015; 15(1):9.
12. Sargin MA, Yassa M, Taymur DB, Ceik A, Ergun E, Niyazi T. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag.2016; 12:657-65
13. Gkrania-Klostsas E, Ye Z, Cooper AJ, Sharp SJ, Luben R, et al. Differential white blood cell count and type 2 diabetes :systematic review and meta-analysis of cross-sectional and prospective study. PLoS One.2010; 5(10):e13405.
14. Hussain Mazhar, Zafar M, Babar M, Hussain NLR: A well assessment tool of glycemic control in type 2 diabetic patients. Pak J Med Sci.2017; 33(6):1366-70.
15. Liu WY, Liu SG, Wang LR, Fang CC, et al. PLR: A novel prognostic factor for predictors of 90-day outcome in critically ill patients with diabetic ketoacidosis. Medicine (Baltimore).2016; 95(4):e2596.
16. Ucler R, Aslan M, Atmaca M, Alay M, Ademoglu EN, Gulsen I. Evalution of NLR and PLR according to plasma glucose status and serum insulin-like growth factor 1 levels in patients with acromegaly. Hum Exp Toxicol.2016; 35(6):608-12.
17. Muraliswaran P, Elamathi, Kanagavalli P, Radhika G. A correlative study of HbA1C and lipid profile parameters among type 2 diabetic population in a rural hospital in Puducherry. IOSR Journal of Dental and Medical Sciences.2016; 15(9):59-63.
18. Khan HA, Sobki SH, Khan SA. Association between glycemic control and serum lipid profile in type 2 diabetic patients: HbA1C predicts dyslipidemia. Clin Exp Med .2007:7: 24-29.
Copyright (c) 2021 Sualeha Ahmed, Muhammad Ali Khalid, Muqadas Munir, Imran Arshad, Muhammad Maaz
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.