Type 2 diabetes mellitus (T2DM) is a most prevalent chronic disease in all parts of the world which is characterized by chronic hyperglycaemia. The prevalence of T2DM is rising with the rapid development of the global economy and lifestyle changes. Epidemiological data indicate that, as of 2021, the global prevalence of T2DM among individuals aged 20–79 years was estimated at 10.5% (536.6 million people), with projections suggesting that over 1.31 billion people worldwide could be affected by 2050, with similar rates observed in both genders [1]. The pathogenesis primarily involves the relative insufficiency of insulin secretion by pancreatic β-cells and the insensitivity of tissues and organs to insulin, which triggers insulin resistance (IR). This leads to a compensatory increase in insulin secretion, ultimately causing pancreatic β-cell damage and failure [2, 3]. In recent years, the NLR has been increasingly studied as a composite biomarker that better reflects the systemic inflammatory state compared to individual biomarkers, being cost-effective and easy to detect [4–6]. Hence, studying the association between T2DM and NLR is reasonable. NLR ratio can be easily determined with the help of complete blood count report. Many studies have been done showing increased neutrophils lymphocyte ratio is a marker of disease related inflammation [7]. Mazhar Hussain et al [8] observed that subjects with normal TLC but increased NLR ratio had increased risk of atherosclerosis which is a key pathological process of cardiovascular complications in diabetics. Heng Wan etal [9] observed increased prevalence of CVD and diabetic kidney disease in subjects with high NLR ratio. SM Ulu et al [10] observed higher NLR ratio as a remarkable marker in diabetic retinopathy evaluation. Hence, this study aims to elucidate the potential relationship between NLR and T2DM.

Aim

To assess the neutrophil and lymphocyte ratio among diabetic and non-diabetic patients.

Objectives

1. Comparing NLR and fasting blood sugar in diabetic and non-diabetic patients
2. Correlation of neutrophil - lymphocyte ratio and fasting blood sugar in diabetic patients.

This study has been conducted in the Department of Physiology in collaboration with Hospital Lab after having clearance from the institutional ethical committee. A Total of 60  (30 Cases & 30 Controls ) subjects with age group 19-60yrs and the diabetic patients who have given written informed  consent and no other co-existing diseases/conditions were included in study and subjects with  known Chronic respiratory disease, psychiatric illnesses endocrinal diseases, hepatic or renal diseases and cardiovascular disease were excluded from   the study. All subjects were investigated for complete blood count, (CBC), Fasting and Postprandial blood sugar. Neutrophil and lymphocyte derived from Complete blood count was done in hematology analyser and fasting blood sugar was done in semi auto analyser .Then, various blood cells and NLR ratio was compared and statistically analysed in both the groups and correlation were done between NLR and FBS in cases. Statistical analysis of the data obtained was performed  using Microsoft Excel, and  tables were generated. Statistical analysis (SPSS, Version 15.0) was done to calculate the unpaired and independent Student's t-test (p value) to find the significance of the results. The results were presented as mean ± SD and p value.

Table 1 and graph 1 shows the comparison of Mean ± SD of neutrophils, lymphocyte between the groups. Neutrophils was higher among cases (64.03±1.24) compared to controls (55.37±1.71). Lymphocyte was found to be lower among cases (24.00±1.01) compared to controls (27.23±1.00). Neutrophils- Lymphocyte ratio was higher among cases (2.80±0.40) compared to controls (1.97±0.18 ). Fasting blood sugar was higher among cases (145.61±11.27) compared to controls ( 87.36± 6.84). The difference is statistically significant with respect to p Value < 0.0001 for all the parameters.

 Table 1 shows comparison of Neutrophil, Lymphocyte and N/L ratio and Fasting blood sugar among cases and controls.

Table 2: Correlation of N/L ratio and Fasting blood sugar in Diabetes mellitus

We have selected subjects from the medicine OPD on the basis of inclusion and exclusion criteria. All subjects were screened for diabetes as per WHO criteria. All those having diabetes were kept in case group and rest were put in control group. We know that diabetes is a condition characterized by hyperglycaemia. This prolonged or chronic hyperglycaemia causes increased non enzymatic glycosylation of proteins leading to formation of advanced glycated products (AGPs). These AGP causes activation of neutrophils. In the present study, we observed an increase in neutrophils count in persons with diabetes mellitus (64.03±1.24) in comparison to non-diabetics (55.37±1.71) . This increase in neutrophils in diabetics was statistically significant. Diabetes associated with chronic stress leads to lymphopenia. In our study, we have observed lower lymphocytes (24.00± 1.01)  in case group in comparison to control group (27.23±1.00) and this difference was statistically significant.

Increase in neutrophils count and decreased lymphocyte count leads to increased neutrophil-lymphocyte ratio in subjects with diabetes mellitus. In our study, we noticed higher NLR (2.80±0.47) ratio in diabetics than non-diabetic control group (1.97±0.18) and the difference was statistically significant. We can conclude from this study that high NLR ratio is associated with the type- II diabetes mellitus.

Research has noted that the NLR ratio tends to be elevated in individuals with newly diagnosed type-2 diabetes. Additionally, it's been found that NLR values are generally higher in the Indian population compared to those in Western countries. There exists a positive correlation between the Neutrophil-Lymphocyte Ratio and type-2 diabetes, suggesting that the NLR ratio could serve as a useful prognostic and monitoring tool for follow-up in diabetic patients, similar to HbA1c. However, further studies are required to validate these findings.

1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.
2. Mahmoud M, Abdel-Rasheed M. Influence of type 2 diabetes and obesity on adipose mesenchymal stem/stromal cell immunoregulation. Cell Tissue Res. 2023;394 (1):33–53.
3. Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, Ostolaza H, Martin C. Pathophysiology of type 2 diabetes Mellitus. Int J Mol Sci 2020, 21(17)
4. Misirlioglu NF, Uzun N, Ozen GD, Calik M, Altinbilek E, Sutasir N, Baykara Sayili S, Uzun H. The relationship between Neutrophil-Lymphocyte ratios with Nutritional Status, Risk of Nutritional Indices, Prognostic Nutritional indices and Morbidity in patients with ischemic stroke. Nutrients 2024, 16(8).
5. Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, Jebarani S, Mohan V. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther. 2014;16(8):524–30.
6. Chen Y, Liu J, Li Y, Cong C, Hu Y, Zhang X, Han Q. The Independent Value of Neutrophil to lymphocyte ratio in Gouty Arthritis: a narrative review. J Inflamm Res. 2023;16:4593–601
7. Balta, S., Ozturk, C., Balta, I., Demirkol, S., Demir, M., Celik, T., & Iyisoy, A. (2016). The neutrophil–lymphocyte ratio and inflammation. Angiology, 67(3), 298-299.
8. Hussain, M., Babar, M. Z. M., Akhtar, L., & Hussain, M. S. (2017). Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in type 2 diabetic patients. Pakistan journal of medical sciences, 33(6), 1366.
9. Wan, H., Wang, Y., Fang, S., Chen, Y., Zhang, W., Xia, F., & Lu, Y. (2020). Associations between the neutrophil-to-lymphocyte ratio and diabetic complications in adults with diabetes: a cross-sectional study. Journal of diabetes research, 2020 .
10. Ulu, S. M., Dogan, M., Ahsen, A., Altug, A., Demir, K., Acartürk, G., & Inan, S. (2013). Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes technology & therapeutics, 15(11), 942-947.