Abstract
Several epidemiological studies have shown that chronic inflammation plays a central role in the pathogenesis of diabetes and its various complications. Neutrophil-lymphocyte ratio (NLR) is a novel potential marker in determining inflammation. The aim of this study was to evaluate the relationship between diabetic microvascular complications, namely diabetic retinopathy, nephropathy, neuropathy, and neutrophil-lymphocyte ratio in type 2 diabetic patients. The study took place in the Unit of Diabetes & Metabolism at the Faculty of Medicine, Alexandria University, Alexandria, Egypt, and included a total of 280 subjects, 200 male patients with type 2 diabetes, 108 of them having one or more microvascular complication, and a control group including 80 healthy age and sex-matched subjects. Results of our study showed that neutrophil-lymphocyte ratio (NLR) values were significantly higher in diabetic patients with retinopathy (p<0.001), neuropathy (p=0.025) and nephropathy (p<0.001) than those of diabetic patients without any microvascular complications and healthy control subjects. NLR levels correlated positively with body mass index (BMI) (r=0.436, p<0.001), glycosylated hemoglobin (HbA1c) (r=0.526, p=0.001) and erythrocyte sedimentation rate (ESR) (r=0.396, p=0.017). Based on the results of this study, we can conclude that neutrophil-lymphocyte ratio (NLR), which is an efficient, simple and stable marker of inflammation, can serve as an important predictor for the presence of microvascular complications in Egyptian patients with type 2 diabetes.
Highlights
Patients with diabetes mellitus commonly develop various chronic vascular complications, including macrovascular diseases and microvascular diseases [1]
All parameters were expressed as mean ± standard deviation. *: Statistically significant at p ≤ 0.05 BMI: body mass index, Fasting Plasma Glucose (FPG): fasting plasma glucose, HbA1c: glycosylated hemoglobin, ESR: erythrocyte sedimentation rate, NS: not significant
The most important finding of our study was that neutrophil-lymphocyte ratio (NLR) levels were significantly higher in diabetic patients with microvascular complications than among diabetic patients with no complications and the control group (p
Summary
Patients with diabetes mellitus commonly develop various chronic vascular complications, including macrovascular diseases (heart disease, stroke and peripheral vascular disease) and microvascular diseases (retinopathy, neuropathy and nephropathy) [1]. There is evidence that chronic inflammation may contribute to both development and acceleration of microangiopathy and macroangiopathy in diabetic patients [5]. Inflammatory cytokines such as TNF-α, IL-1β, IL-6 were found to play a central role in the vicious circle of inflammation, endothelial dysfunction and atherosclerosis in patients with diabetic micro- and macrovascular complications [6, 7]. Previous studies have suggested that chronic low grade inflammation may play a role in the development of insulin resistance, might further proceed to development of overt type 2 diabetes [8]
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