The Relationship Between Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Glycemic Status in Normal Individuals, Prediabetic Patients, and Type 2 Diabetic Patients: A Cross-Sectional Study in Libya
DOI:
https://doi.org/10.65405/dranxs37Keywords:
neutrophil to lymphocyte ratio, platelet-to-lymphocyte ratio, prediabetes, type 2 diabetes, subclinical inflammation, ROC curveAbstract
This study aimed to evaluate the relationship between inflammation markers derived from a complete blood image - white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) - and blood sugar level in normal individuals, pre-diabetic patients, and type 2 diabetics, while studying the effect of age and gender on these indicators and evaluating their predictive value. A cross-sectional analytical study was conducted on 215 individuals (87 males and 128 females), divided into three groups: normal, pre-diabetic, and diabetic. The study relied on complete blood image and blood sugar levels data from laboratory records of a number of laboratories in western Libya during the period from 2 July 2024 to 4 May 2026. The results showed a gradual increase in NLR and PLR values as they moved from the normal group to pre-diabetic and then diabetic, reflecting increased inflammatory activity associated with glucose metabolism disorders. The effect of age and sex on these markers varied by disease stage. A statistically significant direct relationship was found between blood sugar and all indices, with NLR being the strongest correlation followed by PLR, while WBC recorded the weakest diagnostic performance. The study concludes that NLR and PLR are closely related to inflammatory changes associated with blood sugar disorders, and that NLR is the most efficient at distinguishing between the three conditions. These results suggest that these two simple, low-cost indicators can be used in the early detection and follow-up of glucose metabolism disorders.
Downloads
References
Akbas, E. M., Demirtas, L., Ozcicek, A., et al. (2014). Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. International Journal of Clinical and Experimental Medicine, 7(7), 1794-1801.
Bahijri, S. M., Jambi, H. A., Al Raddadi, R. M., Ferns, G., & Tuomilehto, J. (2016). The prevalence of diabetes and prediabetes in the adult population of Jeddah, Saudi Arabia - a community-based survey. PLoS ONE, 11(4), e0152559.
Bi, Y., Gao, Y., Xie, Y., Zhou, M., Liu, Z., Tian, S., & Sun, C. (2024). White blood cells and type 2 diabetes: A Mendelian randomization study. PLOS ONE, 19(3), e0296701.
Dandona, P., Aljada, A., & Bandyopadhyay, A. (2004). Inflammation: the link between insulin resistance, obesity and diabetes. Trends in Immunology, 25(1), 4-7.
Ford, E. S. (2002). Leukocyte count, erythrocyte sedimentation rate, and diabetes incidence in a national sample of US adults. American Journal of Epidemiology, 155(1), 57-64.
Ghasemi, A., & Zahediasl, S. (2012). Normality tests for statistical analysis: a guide for non-statisticians. International Journal of Endocrinology and Metabolism, 10(2), 486-489.
Gkrania-Klotsas, E., Ye, Z., Cooper, A. J., et al. (2010). Differential white blood cell count and type diabetes: systematic review and meta-analysis of cross-sectional and prospective studies. PLoS ONE, 5(10), e13405.
Jiang, H., Yan, W. H., Li, C. J., Wang, A. P., Dou, J. T., & Mu, Y. M. (2014). Elevated white blood cell count is associated with higher risk of glucose metabolism disorders in middle-aged and elderly Chinese people. International Journal of Environmental Research and Public Health, 11(5), 5497-5509.
Liu, F., Wang, T., Wang, S., Zhao, X., & Hua, Y. (2024). The association of platelet to white blood cell ratio with diabetes: a nationwide survey in China. Frontiers in Endocrinology, 15, 1418583.
Lou, M., Luo, P., Tang, R., et al. (2015). Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocrine Disorders, 15, 9.
Martins, I. J., Junqueira, I. C., Nascimento, T. C., Costa, S. H. N., & Alcântara, K. C. (2024). Study of neutrophil/lymphocyte and platelet/lymphocyte ratios in type 2 diabetes mellitus. Bioscience Journal, 40, e40014.
Mertoğlu, C., & Günay, M. (2017). Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(Suppl 1), S127–S131.
Mishra, P., Pandey, C. M., Singh, U., Gupta, A., Sahu, C., & Keshri, A. (2019). Descriptive statistics and normality tests for statistical data. Annals of Cardiac Anaesthesia, 22(1), 67-72.
Mota, M., Popa, S. G., Mota, E., et al. (2016). Prevalence of diabetes mellitus and prediabetes in the adult Romanian population: PREDATORR study. Journal of Diabetes, advance online publication.
Nakanishi, N., Yoshida, H., Matsuo, Y., Suzuki, K., & Tatara, K. (2002). White blood-cell count and the risk of impaired fasting glucose or type II diabetes in middle-aged Japanese men. Diabetologia, 45(1), 42-48.
Pickup, J. C., Mattock, M. B., Chusney, G. D., & Burt, D. (1997). NIDDM as a disease of the innate immune system: association of acute-phase reactants and interleukin-6 with metabolic syndrome X. Diabetologia, 40(11), 1286-1292.
Ryan, A. S. (2000). Insulin resistance with aging: effects of diet and exercise. Sports Medicine, 30(5), 327-346.
Shiny, A., Bibin, Y. S., Shanthirani, C. S., et al. (2014). Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technology & Therapeutics, 16(8), 524-530.
Short, K. R., Vittone, J. L., Bigelow, M. L., et al. (2003). Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes, 52(8), 1888-1896.
Van Herpt, T. T., Ligthart, S., Leening, M. J., et al. (2020). Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria. BMJ Open Diabetes Research & Care, 8(2), e001008.
Wang, Y., Miao, Y., & Wan, Q. (2024). Association of white blood cell count to mean platelet volume ratio with type 2 diabetic peripheral neuropathy in a Chinese population: A cross-sectional study. BMC Endocrine Disorders, 24(1), 1–10.
Ahabaal, T., Gunbaej, E., Majdobe, M. A., & Al_Ashlam, H. (2024). Study OF Glycemic Index In Various Dates In Libya (Barnsali, Tabouni and Dagla). مجلة العلوم الشاملة, 9(33), 38-59.
