Correlation of neutrophil lymphocyte ratio with HbA1c in patients of type 2 diabetes mellitus

Sanjay Varma, Manisha Khande, Preeti Gupta, Archana ., Rajeev Lochan Khare, Yogendra Malhotra, Devpriya Lakra


Background: Neutrophil lymphocyte is an indicator of subclinical inflammation. Type 2 diabetes mellitus is associated with chronic low-grade inflammation. One of the novel inflammatory markers is hemogram derived neutrophil to lymphocyte ratio. There are very few studies which are directly accessing the relation between NLR and HbA1c, so in the present study our aim to correlate neutrophil lymphocyte ratio with glycemic control in patients having type 2 diabetes.

Methods: Hospital based observational cross section study was carried out at department of medicine, Pt JNMMC and Dr BRAM Hospital, Raipur, between September 2018 to August 2019. 105 patients with type 2 diabetes mellitus according to ADA criteria who were aged more than 18 years were included in the study. Relevant investigation and complete blood count were performed. Microsoft excel and SPSS version 25 were used for collection and analysis of the data, p<0.05 was considered as significant.

Results: Out of 105 patients who were given the consent for the study, the ration of male is to female was 1:0.98, mean age of all the patients was 51.77±10.56 years, mean neutrophil lymphocyte ratio among the patients was 6.30±2.646, HbA1c count more than ≥9 was 54 (51.27%). 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: Increased NLR is associated with elevated HbA1c and poor glycemic control. Type NLR should be used as a marker of diabetic control level in addition to HbA1c in type 2 diabetic subjects.


NLR, American heart association, HbA1c, Glycemic control

Full Text:



Alvin CP, Kevin DN, Carmella E-M. Harrison’s principle of internal medicine. 20th ed. 2015;2:2850-2.

Hirosumi J, Tuncman G, Chang L. A central role for JNK in obesity and insulin resistance. Nature. 2002; 420:333-6.

Olefsky JM, Glass CK. Macrophages, inflammation, and insulin resistance. Annu Rev Physiol. 2010;72: 219-46.

Feuerer M, Shen Y, Littman DR. How punctual ablation of regulatory T cells unleashes an autoimmune lesion with the pancreatic islets immunity. Diabetes Technol Ther. 2009; 31:654-64.

Lumeng CN, Bodzin JL, Saltiel AR. Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest. 2007;117:175-84.

Nishimura S, Manabe I, Nagasaki M. CD8+ effector T cells contribute to macrophage recruitment and adipose tissue inflammation in obesity. Nat Med. 2009;15:914-20.

Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study: methodological details. J Diabetes Sci Technol. 2011;5(4):906-14.

Singh PS, Kushwaha A, Kadel AR. Prevalence of Type 2 diabetes mellitus among people attending medical camp in a community hospital. JNMA J Nepal Med Assoc. 2020;58(225):314-7.

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.

Andersson C, van Gaal L, Caterson ID. Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and allcause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes. Diabetologia. 2012;55:2348-55.

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.

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.

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.

Devamsh GN, 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.

Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, et al. Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci. 2019;19(1):1602-6.

Seydahmet A, Liamis G, Liberopoulos E, Barkas F, Elisaf M. Diabetes mellitus and electrolyte disorders. EMJ Diabet. 2019(1):91-6.

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

Mertoglu C, Gunay M. Neutrophil-Lymphocyte ratio and Platelet-Lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes Metab Syndr. 2017;11(1):S127-31.