Study of neutrophil lymphocyte ratio in patients with type 2 diabetes mellitus and its correlation with glycemic control


  • Devamsh G. N. Department of Medicine, Bangalore Medical College and Research Institute, KR ROAD, Bengaluru, Karnataka, India
  • Parvathi M. Department of Medicine, Bangalore Medical College and Research Institute, KR ROAD, Bengaluru, Karnataka, India
  • Madhumathi R. Department of Medicine, Bangalore Medical College and Research Institute, KR ROAD, Bengaluru, Karnataka, India
  • Leela Raghavan Department of Medicine, Bangalore Medical College and Research Institute, KR ROAD, Bengaluru, Karnataka, India



Neutrophil lymphocyte ratio, HbA1c, Glycemic control


Background: Neutrophil lymphocyte ratio (NLR) is an indicator of subclinical inflammation. Subclinical inflammation may be associated with increased cardiovascular risk. Raised NLR is associated with metabolic syndrome and is found to be a predictor of cardiovascular disorders. There are only few studies assessing the correlation between NLR and glycemic control. The aim of the present study is to investigate the relationship between NLR and glycemic control in type 2 diabetes patients.

Methods: This observational study was conducted in Department of Medicine, Bangalore medical college. 100 patients diagnosed to have type 2 diabetes mellitus were assessed. They were divided into three groups based upon HbA1c levels: Group 1, HbA1c ≤7%; group 2, HbA1c 7-9%, and group 3, HbA1c>9%. Complete blood count and other relevant investigations were performed. SPSS software was used for statistical analysis. T test was used for continuous variables and chi square test for categorical variables. ANOVA test was used to compare three groups. A p value of <0.05 was considered statistically significant.

Results: Out of 100 patients, the white blood cell count (WBC count) was higher in group 3 as compared to group 1 and group 2(p 0.008). Similarly, the absolute neutrophil count was higher in group 3 as compared to group 1 and group 2(p.017). The neutrophil lymphocyte ratio (NLR) was significantly higher in group 3 as compared with group 1 and group 2(p.009). NLR had a positive correlation with HbA1c and was found to be an independent predictor of poor glycemic control in patients with type 2 diabetes mellitus

Conclusions: Our study found a significant positive correlation between NLR and glycemic control. Increased NLR is associated with elevated HbA1c and poor glycemic control. Type 2 diabetes mellitus patients with raised NLR should be evaluated for cardiovascular, renal and ocular complications of diabetes.


Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison’s principles of internal medicine. 19th edition, New York: McGraw-Hill; 2015;2,16:3178-3209.

Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States. Atlanta, GA. US Department of Health and Human Services, Centers for Disease Control and Prevention; 2007.

The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee in the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S5-20.

Bagdade JD, Root RK, Bulger RJ. Impaired Leukocyte Function in Patients with Poorly Controlled Diabetes. Diabetes. 1974;23(1):9-15.

Ernst E, Matrai A. Altered red and white blood cell rheology in type II Diabetes. Diabetes. 1986;35(12):1412-535(12):1412-5.

Pécsvarády Z, Ficher TC, Darwin CH, Fabok A, Maqueda TS, Saad MF, et al. Decreased polymorphonuclear leukocyte deformability in NIDDM. Dia Care 1994 Jan 1;17(1):57-63.

Mowat AG, Baum J (1971) Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N Engl J Med 284(12):621-27.

Delamaire M, Maquendre D, Moreno M, Legoff MC, Allanic H, Genetet B. Impaired leucocyte functions indiabetic patients. Diabet Med.1997 Jan;14(1):29-34.

Shah BR, Hux JE (2003) Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care.2003 Feb 1;26(2):510-13.

Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology 2011;11(4):445-52.

Bhutta H, Agha R, Wong J, Tang TY, Wilson YG, Walsh SR. Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a crosssectional study. Vasc Endo Surg 2011;45(3):227-31.

Ozturk C, Balta S, Balta I, Demirkol S, Celik T, Turker T, et al. Neutrophil–lymphocyte ratio and carotid–intima media thickness in patients with Behcet disease without cardiovascular involvement. Angio. 2015 Mar;66(3):291-6.

Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The relation between atherosclerosis and the neutrophil–lymphocyte ratio. Clinical applied thrombosis/hemostasis. 2016 Jul;22(5):405-11.

Balta S, Kurtoglu E, Kucuk U, Demirkol S, Ozturk C. Neutrophil–lymphocyte ratio as an important assessment tool. Expert review cardiova ther. 2014 May 1;12(5):537-8.

Lyons TJ, Basu A. Biomarkers in diabetes: hemoglobin A1c, vascular and tissue markers. Translational Research. 2012 Apr 1;159(4):303-12.

Selfil F, Ulutas KT, Dokuyucu R, Sumbul AT, Yengil E, Yagiz AE, et al. 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.

Hussain M, Babar MZM, Akhtar L, Hussain MS. Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in Type- 2 diabetic patients. Pak J Med Sci. 2017;33(6):1366-70.

Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, et al. Association of neutrophil lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther. 2014;16(8):524-30.

Oh Y, Kwon GC, Koo SH, Kim J. Association between glycemic control and hematolical indices in type 2 diabetic patients. Lab Med Online. 2016;6(3):134-9.

Demirtas L, Degirmenci H, Akbas EM, Ozcicek A, Timuroglu A, Gurel A, et al. Association of haematological indices with diabetes, impaired glucose regulation and microvascular complications of diabetes. Int J Clin Exp Med. 2015;8(7):11420-7.

Chittawar,S., Khandare,S., Nahar, N., Dubey,T., Qureshi,Z.. Study of neutrophil-lymphocyte ratio as novel marker for diabetic nephropathy in type 2 diabetes. Ind J Endocr Metab. 2017;21(3):387-92.

Srinivas B, Maldar A, Bellad A, Mukhi N. Relation of neutrophilic lymphocyte ratio to microvascular complications of diabetes mellitus. Int J Health Sci Res. 2015;5(12):34-8.

Kahraman C, Kahraman NK, Aras B, Coşgun, S, Gülcan E. The relationship between neutrophil-to-lymphocyte ratio and albuminuria in type 2 diabetic patients: a pilot study, Arch Med Sci. 2016;12(3):571-5.






Original Research Articles