Correlation of newer inflammatory markers in patients with type 2 diabetes mellitus: A cross-sectional study

Abstract

Background: Globally, diabetes mellitus (DM) is a major health concerns and has reached alarming levels. DM is a group of metabolic disorders characterized by hyperglycemia leading to micro- and macro-vascular complications. Chronic low-grade inflammation is associated with the pathophysiology of DM.

Aims and Objectives: The present study aimed to assess the levels of neutrophil-to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and other inflammatory markers in T2DM patients and their correlation with blood sugar and HbA1c.

Materials and Methods: This cross-sectional study was conducted in Department of Biochemistry in association with Department of General Medicine and Pathology, NRI Institute of Medical Sciences (NRIIMS), Visakhapatnam, Andhra Pradesh, India. In this study, 90 T2DM patients and 90 non-diabetic subjects were recruited. Fasting and post-prandial blood samples were collected and used for the estimation of blood sugar, urea, creatinine, and lipid profile parameters. Whole blood (EDTA) samples were used for analysis of complete blood count (CBC) and HbA1c. NLR, PLR, SII, SIRI, MHR, NHR, LHR, and PHR were calculated from CBC values. Demographic details were collected.

Results: In this study, significant increase in blood pressure (systolic [120.4±8.1 mmHg], diastolic [80.2±4.8 mmHg]), fasting blood sugar (FBS) (162.5±53.7 mg/dL), post-prandial blood sugar (238.3±78.8 mg/dL), HbA1c (8.5±2.2%), urea (28.6±8.6 mg/dL), creatinine (1.1±0.2 mg/dL), total cholesterol (186.8±46.1 mg/dL), triglycerides (168.9±61.2 mg/dL), LDLC (115.0±36.3 mg/dL), VLDL (33.8±12.4 mg/dL), and neutrophil count (66.6±11.4%) was observed in T2DM cases. Inflammatory markers such as NLR (4.2±1.1), PLR (0.17±0.01), SII (12.6±3.6), SIRI (25.7±5.2), MHR (0.15±0.08), NHR (1.9±0.72), and PHR (0.07±0.02) were significantly increased in T2DM cases than non-diabetic subjects. FBS was positively correlated with SIRI (r=0.180), MHR (r=0.257), NHR (r=0.418), and PHR (r=0.212). Similarly, HbA1c positively correlated with NHR (r=0.353) and PHR (r=0.177) in T2DM subjects. In this study, HDLC level and lymphocyte count was significantly decreased in T2DM cases.

Conclusion: The study may conclude that increased levels of NLR, PLR, SII, SIRI, MHR, NHR, and PHR in T2DM and their positive correlation with blood sugar and HbA1c may serve as alternate markers of inflammation and are useful to assess the impact of systemic inflammatory response in T2DM patients.