The Association Between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Overview

Journal J Diabetes Res

Publisher Wiley

Specialty Endocrinology

Date 2023 Jun 12

PMID 37305430

Authors

Tiruneh Adane

Mulugeta Melku

Yilkal Belete Worku

Alebachew Fasil

Melak Aynalem

Amanuel Kelem

Solomon Getawa

Affiliations

Soon will be listed here.

Abstract

Background: Glycated hemoglobin (HbA1c) is a commonly used clinical marker to monitor the control of type 2 diabetes mellitus patients (T2DM). However, it is unable to identify the ongoing inflammatory changes in the body. These factors could be easily identified and monitored by the neutrophil-to-lymphocyte ratio (NLR). Therefore, this study is aimed at investigating the relationship between NLR and glycemic control in T2DM.

Method: A comprehensive search of eligible studies was performed in various databases published until July 2021. A random effect model was used to estimate the standardized mean difference (SMD). A metaregression, subgroup, and sensitivity analysis were conducted to search for potential sources of heterogeneity.

Result: A total of 13 studies were included in this study. Accordingly, the SMD of the NLR values between the poor and good glycemic control groups was 0.79 (95% CI, 0.46-1.12). Our study also showed that high NLR was significantly associated with poor glycemic control in T2DM patients (OR = 1.50, 95% CI: 1.30-1.93).

Conclusion: The results of this study suggest an association between high NLR values and an elevated HbA1C in T2DM patients. Therefore, NLR should be considered a marker of glycemic control in addition to HbA1c in T2DM patients.

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References

Sefil F, Ulutas K, Dokuyucu R, Sumbul A, Yengil E, Yagiz A . Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res. 2014; 42(2):581-8. DOI: 10.1177/0300060513516944. View

Tsalamandris S, Antonopoulos A, Oikonomou E, Papamikroulis G, Vogiatzi G, Papaioannou S . The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. Eur Cardiol. 2019; 14(1):50-59. PMC: 6523054. DOI: 10.15420/ecr.2018.33.1. View

Pertynska-Marczewska M, Kiriakidis S, Wait R, Beech J, Feldmann M, Paleolog E . Advanced glycation end products upregulate angiogenic and pro-inflammatory cytokine production in human monocyte/macrophages. Cytokine. 2004; 28(1):35-47. DOI: 10.1016/j.cyto.2004.06.006. View

. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2003; 27 Suppl 1:S5-S10. DOI: 10.2337/diacare.27.2007.s5. View

Yuksel M, Yildiz A, Oylumlu M, Turkcu F, Zihni Bilik M, Ekinci A . Novel markers of endothelial dysfunction and inflammation in Behçet's disease patients with ocular involvement: epicardial fat thickness, carotid intima media thickness, serum ADMA level, and neutrophil-to-lymphocyte ratio. Clin Rheumatol. 2015; 35(3):701-8. DOI: 10.1007/s10067-015-2907-0. View

Srinivasagopalane B, Andrew Rajarathinam S, Balasubramaiyan T . Clinical pertinence of neutrophil-to- lymphocyte ratio among hypertensives with different grades and duration of hypertension - an insight. Clin Exp Hypertens. 2018; 41(4):394-399. DOI: 10.1080/10641963.2018.1510942. View

Walsh S, Cook E, Goulder F, Justin T, Keeling N . Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005; 91(3):181-4. DOI: 10.1002/jso.20329. View

Templeton A, McNamara M, Seruga B, Vera-Badillo F, Aneja P, Ocana A . Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014; 106(6):dju124. DOI: 10.1093/jnci/dju124. View

Aktas G . Hematological predictors of novel Coronavirus infection. Rev Assoc Med Bras (1992). 2021; 67Suppl 1(Suppl 1):1-2. DOI: 10.1590/1806-9282.67.Suppl1.20200678. View

10.

Forget P, Khalifa C, Defour J, Latinne D, Van Pel M, De Kock M . What is the normal value of the neutrophil-to-lymphocyte ratio?. BMC Res Notes. 2017; 10(1):12. PMC: 5217256. DOI: 10.1186/s13104-016-2335-5. View

11.

Chittawar S, Dutta D, Qureshi Z, Surana V, Khandare S, Dubey T . Neutrophil-lymphocyte Ratio is a Novel Reliable Predictor of Nephropathy, Retinopathy, and Coronary Artery Disease in Indians with Type-2 Diabetes. Indian J Endocrinol Metab. 2017; 21(6):864-870. PMC: 5729675. DOI: 10.4103/ijem.IJEM_197_17. View

12.

Fonseka T, McIntyre R, Soczynska J, Kennedy S . Novel investigational drugs targeting IL-6 signaling for the treatment of depression. Expert Opin Investig Drugs. 2015; 24(4):459-75. DOI: 10.1517/13543784.2014.998334. View

13.

Angkananard T, Anothaisintawee T, McEvoy M, Attia J, Thakkinstian A . Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018; 2018:2703518. PMC: 6252240. DOI: 10.1155/2018/2703518. View

14.

Palella E, Cimino R, Pullano S, Fiorillo A, Gulletta E, Brunetti A . Laboratory Parameters of Hemostasis, Adhesion Molecules, and Inflammation in Type 2 Diabetes Mellitus: Correlation with Glycemic Control. Int J Environ Res Public Health. 2020; 17(1). PMC: 6982208. DOI: 10.3390/ijerph17010300. View

15.

. 6. Glycemic Targets: . Diabetes Care. 2018; 42(Suppl 1):S61-S70. DOI: 10.2337/dc19-S006. View

16.

Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E . Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis. Rev Assoc Med Bras (1992). 2018; 63(12):1065-1068. DOI: 10.1590/1806-9282.63.12.1065. View

17.

Hussain M, Saeed M, Babar M, Atif M, Akhtar L . Nebivolol Attenuates Neutrophil Lymphocyte Ratio: A Marker of Subclinical Inflammation in Hypertensive Patients. Int J Hypertens. 2017; 2017:7643628. PMC: 5551516. DOI: 10.1155/2017/7643628. View

18.

Abdel-Moneim A, Semmler M, Abdel-Reheim E, Zanaty M, Addaleel W . Association of glycemic status and interferon-γ production with leukocytes and platelet indices alterations in type2 diabetes. Diabetes Metab Syndr. 2019; 13(3):1963-1969. DOI: 10.1016/j.dsx.2019.04.046. View

19.

Jhuang Y, Kao T, Peng T, Chen W, Li Y, Chang P . Neutrophil to lymphocyte ratio as predictor for incident hypertension: a 9-year cohort study in Taiwan. Hypertens Res. 2019; 42(8):1209-1214. PMC: 8075864. DOI: 10.1038/s41440-019-0245-3. View

20.

Fontana G, Lapolla A, Sanzari M, Piva E, Mussap M, De Toni S . An immunological evaluation of type II diabetic patients with periodontal disease. J Diabetes Complications. 1999; 13(1):23-30. DOI: 10.1016/s1056-8727(98)00021-x. View