A study of the platelet lymphocyte ratio as a predictive marker of prediabetes and diabetes mellitus and its correlation with hba1c

Introduction: Diabetes is a multifaceted metabolic disorder affecting the glucose status of the human body. Pathogenesis of type 2 diabetes mellitus is an inflammatory process. Chronic inflammation plays a central role in the development and progression of diabetes, and in the pathogenesis of its complications. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are indicators of subclinical inflammation. This study was planned to find the association of platelet to lymphocyte ratio with diabetes as well as HbA1c in patients with type 2 diabetes mellitus. Material and Methods: The study was a hospital based descriptive cross-sectional study. The study population comprised of Prediabetic & Diabetes Mellitus Patients attending General Medicine OPD as well as admitted in these wards after approval from Institutional Ethical Committee and written informed consent was obtained from the participating patients. Similar age and sex matched healthy control were enrolled in the study. The sample size was calculated using open epi info software v. 3.0. Detailed history, examination and a group of tests CBC, DLC, ESR, CRP, Hb1Ac, Urine Routine was done. Calculation of Platelet lymphocyte ratio (PLR) in each study group. Results: In our study, 100 diabetic cases and 100 controls were evaluated. Out of 100 subjects, 17 were prediabetic and 83 were diabetics. Majority of study subjects had diabetes between 1-5 years (59%) followed by 6-10 years (19.3%) and 11-15years (12%). 08 (9.6%) subjects were having diabetes since >15 years. ESR, marker of inflammation was found to be raised in diabetic group with a mean value of 26.75±14.54 when compared to control (12.40±4.83) with a p value of <0.001. The PLR was calculated to be 122.43±12.89 in diabetic group and 106.81±10.12 in the control group, e.g., PLR was higher in patients with hyperglycemia and the result was statistically significant (p value <0.001). Mean NLR among diabetic cases was 2.24±0.77, while that in controls was lower (1.24±0.17). This difference was found to be statistically significant (p<0.001). There was moderate positive correlation between HbA1c and PLR (r value = 0.45; p value <0.001) & HbA1c and NLR (r value = 0.36; p value <0.001). There was moderate positive significant correlation between duration of diabetes and PLR (r value = 0.40; p value <0.001) & duration of diabetes and NLR (r value = 0.34; p value <0.001). Conclusion: In conclusion, increased PLR were found to be useful predictors of diabetes. As in earlier studies, NLR and PLR were found to be indicators of chronic inflammation in prediabetes and diabetes. A significant finding of this study is that the NLR and PLR values were significantly different between the cases and controls. If this finding is confirmed by future studies with larger series and different patient groups, NLR and PLR values can be used for the diagnosis of diabetes as a simpler and cost-effective alternative to HbA1c. In diabetic patients, NLR and PLR deterioration is associated with uncontrolled glycemic status, thereby increasing the importance of hemogram in during follow up of diabetic patients.