Background: The prevalence of diabetes mellitus in the general population has been increasing in recent years, and diabetes-related complications contribute substantially to morbidity, mortality, and healthcare system burden. This study aimed to evaluate the relationship between glycated hemoglobin (HbA1c) levels and inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in individuals diagnosed with type 2 diabetes mellitus (T2DM).
Methods: This retrospective case-control with longitudinal follow-up study included 138 patients with T2DM followed at the Internal Medicine Outpatient Clinic of Başakşehir Çam and Sakura City Hospital (HbA1c > 7%: n = 37; HbA1c < 7%: n = 101) and 118 healthy control subjects. HbA1c, white blood cell (WBC) count, NLR, MLR, and PLR values obtained at baseline and follow-up outpatient visits were retrospectively retrieved from the hospital information system and compared between groups.
Results: Glucose and HbA1c levels differed significantly among the groups, with the highest values observed in the uncontrolled diabetes group (p < 0.001). WBC and neutrophil counts were also significantly higher in patients with uncontrolled diabetes (p < 0.001). Monocyte counts, as well as NLR and MLR levels, were significantly increased in this group (p < 0.05). At the third-month follow-up, patients in the uncontrolled diabetes group exhibited significant changes in glucose, HbA1c, neutrophil, lymphocyte, NLR, and PLR levels (p < 0.05), whereas the change in MLR did not reach statistical significance (p = 0.083). Correlation analysis demonstrated significant positive associations between diabetes duration, glucose, and HbA1c levels and both NLR and MLR (r = 0.316-0.354, p < 0.001). Additionally, moderate positive correlations were observed among NLR, MLR, and PLR at both baseline and third-month measurements (p < 0.001).
Conclusion: NLR, MLR, and PLR are low-cost and easily accessible inflammatory markers that change in parallel with HbA1c levels and may be useful for monitoring glycemic control and disease progression in T2DM. These findings support the potential clinical utility of inflammation-based risk assessment in patients with type 2 diabetes mellitus.
https://link.springer.com/article/10.1186/s12902-026-02337-4
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