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2025, Number 1

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Aten Fam 2025; 32 (1)

Relationship Between Microvascular Complications and Elevated Neutrophil-to-Lymphocyte Ratio in Patients with Diabetes Mellitus

Rico-Chávez P, Pérez-Pérez M, Reyes-Jiménez O

Language: Spanish
References: 34
Page: 11-17
PDF size: 315.62 Kb.


ABSTRACT

Objective: To evaluate the relationship between microvascular complications and elevated neutrophil-to-lymphocyte ratio (NLR) values in patients with type 2 diabetes mellitus (T2DM) from a family medicine unit. Methods: A crosssectional analytical study was conducted at Family Medicine Unit 92 of the Mexican Institute of Social Security. A total of 232 medical records of T2DM patients were analyzed through probabilistic sampling. A data collection form, designed by the researchers, was used to collect sociodemographic, biochemical, and clinical variables, which were analyzed with GraphPad Prism 10 using χ2 and Student’s t-tests. Results with a pvalue ‹0.05 were considered statistically significant. Results: NLR was calculated for each medical record, and it was found that 51 patients (22%) had elevated NLR values. Elevated NLR was associated with sex, hypertension, and poor glycemic control (p‹0.05) but not with body mass index (BMI), age, and duration of T2DM. A statistically significant relationship was observed between elevated NLR and the presence of microvascular complications such as nephropathy, neuropathy, cardiopathy, and retinopathy (p‹0.05). Logistic regression analysis showed a significant association between elevated NLR and diabetic cardiopathy (OR: 7.93, 95% CI, 3.29-20.33, p‹0.05). Conclusion: Elevated NLR values were associated with the presence of microvascular complications in T2DM patients, suggesting that NLR may be useful as a biomarker for managing diabetic patients in family medicine consultations.


REFERENCES

  1. Organización Panamericana de la Salud (OPS). Diabetes[Internet]. [Citado 2024 Mayo 27]. Disponibleen: https://www.paho.org/es/temas/diabetes

  2. Bello-Chavolla OY, Antonio-Villa NE, Fermín-Martínez CA, Fernández-Chirino L,Vargas-Vázquez A, Ramírez-García D, et al.Diabetes-Related Excess Mortality in Mexico: AComparative Analysis of National Death RegistriesBetween 2017–2019 and 2020. Diabetes Care.2022;45(12):2957–2966.

  3. Kolarić V. Chronic Complications of Diabetes andQuality of Life. Acta Clin Croat. 2022;61(1):520–527.

  4. Tsalamandris S, Antonopoulos AS, Oikonomou E,Papamikroulis GA, Vogiatzi G, Papaioannou S, etal. The Role of Inflammation in Diabetes: CurrentConcepts and Future Perspectives. Eur CardiolRev. 2019;14(1):50–59.

  5. Nedosugova LV, Markina YV, Bochkareva LA,Kuzina IA, Petunina NA, Yudina IY, et al. InflammatoryMechanisms of Diabetes and Its VascularComplications. Biomedicines. 2022;10(5):1168.

  6. Randeria SN, Thomson GJA, Nell TA, RobertsT, Pretorius E. Inflammatory cytokines in type 2diabetes mellitus as facilitators of hypercoagulationand abnormal clot formation. Cardiovasc Diabetol.2019;18(72):1–15.

  7. Mohammad WH, Ahmad AB, Al-Maghraby MH,Abdelrhman MZ, Ezzate S. Is neutrophil-lymphocyteratio a novel biomarker for macrovascular andmicrovascular complications of type 2 diabetes?Egypt J Intern Med. 2019;31(1):1–7.

  8. Zahorec R. Neutrophil-to-lymphocyte ratio, past,present and future perspectives. Bratisl Med J.2021;122(07):474–488.

  9. Forget P, Khalifa C, Defour JP, Latinne D, Van PelMC, De Kock M. What is the normal value of theneutrophil-to-lymphocyte ratio? BMC Res Notes.2017;10(12):1–4.

  10. Akin S, Aydin Z, Yilmaz G, Aliustaoglu M, KeskinO. Evaluation of The Relationship BetweenGlycaemic Regulation Parameters and Neutrophilto-Lymphocyte Ratio in Type 2 Diabetic Patients.EMJ Diabetes. 2019;7(1):91–96.

  11. Duman TT, Aktas G, Atak BM, Kocak MZ, ErkusE, Savli H. Neutrophil to lymphocyte ratio as anindicative of diabetic control level in type 2 diabetesmellitus. Afr Health Sci. 2019;19(1):1602–1606.

  12. Adane T, Melku M, Worku YB, Fasil A, AynalemM, Kelem A, et al. The Association betweenNeutrophil-to-Lymphocyte Ratio and GlycemicControl in Type 2 Diabetes Mellitus: A SystematicReview and Meta-Analysis. J Diabetes Res.2023;2023:1–11.

  13. Bhattacharyya S, Jain N, Verma H, Sharma K. ACross-sectional Study to Assess Neutrophil LymphocyteRatio as a Predictor of MicrovascularComplications in Type 2 Diabetes Mellitus Patients.J Clin Diagn Res. 2021;15(8):59–62.

  14. Eissa MS, Abou-ElEzz S, Kanzel SM, Mady M.Neutrophil-lymphocyte ratio and its relation tomicrovascular complication in geriatric patientswith diabetes: a case-controlled study. Egypt J InternMed. 2022;22(34):94.

  15. Maravilla Domínguez MA, Zermeño GonzálezMDL, Zavaleta Muñiz ER, Montes Varela VA,Irecta Nájera CA, Fajardo Robledo NS, et al. Inflammationand atherogenic markers in patientswith type 2 diabetes mellitus. Clínica E InvestigEn Arterioscler Engl Ed. 2022;34(3):105–12.

  16. Inker LA, Eneanya ND, Coresh J, Tighiouart H,Wang D, Sang Y, et al. New Creatinine- and CystatinC–Based Equations to Estimate GFR withoutRace. N Engl J Med. 2021;385(19):1737–1749.

  17. Organización Mundial de la Salud (OMS). Obesidady sobrepeso [Internet]. [Citado 2024 Mayo27]. Disponible en: https://www.who.int/es/newsroom/fact-sheets/detail/obesity-and-overweight.

  18. American Heart Association (AHA). UnderstandingBlood Pressure Readings [Internet]. [Citado2024 Mayo 27]. Disponible en: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

  19. American Diabetes Association Professional PracticeCommittee. Diagnosis and Classification ofDiabetes: Standards of Care in Diabetes—2024.Diabetes Care. 2024;47(Suppl 1):S20-S42.

  20. Mishriky BM, Cummings DM, Powell JR. Diabetes-Related Microvascular Complications – APractical Approach. Prim Care Clin Off Pract.2022;49(2):239–254.

  21. Lorenzo-Almorós A, Tuñón J, Orejas M, CortésM, Egido J, Lorenzo Ó. Diagnostic approachesfor diabetic cardiomyopathy. Cardiovasc Diabetol.2017;16(28):1–14.

  22. Haneda M, Utsunomiya K, Koya D, Babazono T,Moriya T, Makino H, et al. A new classification ofDiabetic Nephropathy 2014: a report from JointCommittee on Diabetic Nephropathy. DiabetolInt. 2014;5(4):207–211.

  23. Menini S, Iacobini C, Vitale M, Pugliese G. TheInflammasome in Chronic Complications ofDiabetes and Related Metabolic Disorders. Cells.2020;9(8):1812.

  24. Luc K, Schramm-Luc A, Guzik TJ, MikolajczykTP. Oxidative stress and inflammatory markersin prediabetes and diabetes. J Physiol Pharmacol.2019;70(6):809–824.

  25. Mahajan M, Prasad MK, Ashok C, Guria RT, MarandiS, Vidyapati, et al. The Correlation of theNeutrophil-to-Lymphocyte Ratio With MicrovascularComplications in Patients With DiabetesMellitus. Cureus. 2023;15(9):e44601.

  26. Dascalu AM, Georgescu A, Costea AC, Tribus L,El Youssoufi A, Serban D, et al. Association BetweenNeutrophil-to-Lymphocyte Ratio (NLR)and Platelet-to-Lymphocyte Ratio (PLR) WithDiabetic Retinopathy in Type 2 Diabetic Patients.Cureus. 2023; 15(11):e48581.

  27. Trtica Majnarić L, Guljaš S, Bosnić Z, Šerić V,Wittlinger T. Neutrophil-to-Lymphocyte Ratioas a Cardiovascular Risk Marker May Be Less Efficientin Women Than in Men. Biomolecules.2021;11(528):1–17.

  28. Chittawar S, Dutta D, Qureshi Z, Surana V,Khandare S, Dubey TN. Neutrophil-lymphocyteratio is a novel reliable predictor of nephropathy,retinopathy, and coronary artery disease in Indianswith type-2 diabetes. Indian J Endocrinol Metab.2017;21(6):864–870.

  29. Hong S, He H, Fang P, Liu S, Chen C. Associationof neutrophil-to-lymphocyte ratio and risk of cardiovascularand all-cause mortality in hypertensionpatients. Heliyon. 2024; 10(6):e27517.

  30. Wan H, Wang Y, Fang S, Chen Y, Zhang W, XiaF, et al. Associations between the Neutrophil-to-Lymphocyte Ratio and Diabetic Complications inAdults with Diabetes: A Cross-Sectional Study. JDiabetes Res. 2020:6219545.

  31. Jaaban M, Zetoune AB, Hesenow S, HessenowR. Neutrophil-lymphocyte ratio and plateletlymphocyteratio as novel risk markers for diabeticnephropathy in patients with type 2 diabetes. Heliyon.2021; 7(7):e07564.

  32. Rahar, Marwah S, Kulshreshtha B. Neutrophillymphocyte ratio (NLR) in type 2 diabetes mellitusand its correlation with renal function: Aninstitutional experience. J Dr NTR Univ HealthSci. 2021;10(2):82–87.

  33. Sefil F, Ulutas KT, Dokuyucu R, Sumbul AT,Yengil E, Yagiz AE, et al. Investigation of neutrophillymphocyte ratio and blood glucose regulationin patients with type 2 diabetes mellitus. J IntMed Res. 2014;42(2):581–588.

  34. El-Tawab SS, Ibrahim IK, Megallaa MH, MgeedRMA, Elemary WS. Neutrophil–lymphocyte ratioas a reliable marker to predict pre-clinical retinopathyamong type 2 diabetic patients. Egypt RheumatolRehabil. 2023;50(11):1–9.




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