Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in Type-2 diabetic patients

Background and Objective: Increased neutrophil lymphocyte ratio (NLR) is a marker as well as predictor of various cardiac and non cardiac disorders. Our aim was to assess the relationship between NLR and different level of glycemic control in type 2 diabetic patients.

Methods: An observational study was conducted at diabetic clinic of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from September 2016 to February 2017 in which 330 type 2 diabetic patients were randomly divided in to three groups based upon diabetes control according to ADA criteria. Patients in group A with HbA1c ≤ 7% (excellent control), group B HbA1c 7.0-9.0 % (poor control) and group C HbA1c ≥ 9 %( worst control). Patients were assessed in terms of complete blood count and C - reactive protein.

Results: As compared to excellent control (Group A) patients with worst control (Group C)showed a high leukocyte count (p .001), high neutrophil count (P .003) and lower lymphocyte count (P 0.44) while patients in poor control (Group B)did not differ significantly. Similarly value of NLR was also significantly higher in worst control (Group C) as compared to poor control(Group B) and excellent control (Group A) diabetes (4.3±2.8, 2.7±1.0 and2.0±0.5(p.001). NLR were found independent predictor of worst diabetes control (OR: 1.809, 95% CI: 1.459-2.401) along with fasting blood sugar (OR: 0.938, 95% CI: 0.995-0.982) and CRP (OR: 1.020, 95% CI: 1.003-1.028).

Conclusion: Increased NLR level is associated with elevated HbA1c and poor glycemic control in patients of type 2 diabetes mellitus. It can be used as a disease monitoring tool during the follow up of diabetic patients.