NEUTROPHIL LYMPHOCYTE RATIO AS AN EVALUATION TOOL FOR THE GLYCEMIC CONTROL IN PATIENTS SUFFERING FROM DIABETES

Objective: Enhanced neutrophil lymphocyte ratio is the predictor and identifier for many cardiac as well as non-cardiac complications. The purpose of this study is to evaluate the association between neutrophil lymphocyte ratio and various glycemic control levels in the patients suffering from Type-2 diabetes. Methodology: This is an observational research work conducted at Lahore General Hospital from November 2018 to April 2019. In this research work, 330 diabetic patients were separated into 3 groups depending upon the control of diabetes in accordance with the criteria defined by ADA. Group-A contains the patients with HbA1c ≤ 7.0% with excellent control, Group-B HbA1c 7.0 to 9.0 % with poor control and Group-C HbA1c ≥ 9.0% with worst control. We evaluated the patients in terms of C-reactive protein and count of complete blood. Results: Comparison of the Group-A patients with the patients of Group-C displayed a high count of leukocyte (P: 0.001), high count of neutrophil (P: 0.003) and lower count of lymphocyte (P: 0.440) whereas patients in Group-B were not significant different. In the same manner, neutrophil lymphocyte ratio value was much high in the patients of Group-C in comparison with the patients of Group-B and Group-A (4.30 ± 2.80, 2.70 ± 1.0 and 2.0 ± 0.50 (P: 0.001). We discovered the neutrophil lymphocyte ratio as an independent predictor of the adverse control of diabetes (OR= 1.8090, 95.0% CI= 1.459 to 2.401) along with FBS (Fasting Blood Sugar) (OR= 0.9380, 95.0% CI= 0.995 to 0.982) and CRP (OR= 1.02, 95.0% CI= 1.003 to 1.028). Conclusion: Enhanced level of neutrophil lymphocyte ratio has association with the increased HbA1c and adverse glycemic control among patients suffering from Type-2 Diabetes Mellitus. This tool can be used as a disease monitoring tool in the duration of the follow up period of the patients. KEYWORDS: Neutrophil Lymphocyte Ratio, Blood Count, Neutrophil. Diabetes Mellitus