Blood leukocyte composition and neutrophil to lymphocyte ratio in patients with newly diagnosed type 2 diabetes mellitus depending on the degree of overweight/obesity

Authors

  • O.V. Furmanova SI “V.P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine”, Kyiv, Ukraine
  • K.P. Zak SI “V.P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine”, Kyiv, Ukraine
  • V.V. Popova SI “V.P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine”, Kyiv, Ukraine http://orcid.org/0000-0002-4116-0671
  • M.D. Tronko SI “V.P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine”, Kyiv, Ukraine http://orcid.org/0000-0001-7421-0981

DOI:

https://doi.org/10.22141/2224-0721.16.7.2020.219006

Keywords:

type 2 diabetes mellitus, immunity, inflammation, blood leukocyte composition

Abstract

Background. According to the current hypothesis, type 2 diabetes mellitus (T2DM) is chronic low-gradient inflammation. Almost 80 % of patients with type 2 diabetes are obese. However, such important biomarkers of inflammation as the leukocyte composition of the blood and the neutrophil-to-lymphocyte ratio (NLR) in patients with newly diagnosed type T2DM and varying degrees of obesity remain poorly understood. The purpose was to study the leukocyte composition and the index of inflammation NLR in non-hematological patients with newly diagnosed type 2 diabetes, depending on different body weights. Materials and methods. The study involved 108 patients with newly diagnosed T2DM aged 40–70 years and 50 normoglycemic individuals with different body mass index (BMI). The total number of blood leukocytes was determined using a hematological analyzer, and the leukocyte composition was determined both with an analyzer and in blood smears stained according to the Pappenheim staining method using a cacodylate buffer (Ph 6.85) per 200 identified cells. The index of inflammation NLR was calculated by dividing the absolute neutrophil count by the lymphocyte count. Results. Compared to healthy people, T2DM patients are characterized by a small but significant (p < 0.05) increase in the total number of leukocytes, the absolute number of neutrophils and monocytes, and the index of inflammation NLR. When dividing the entire group of T2DM patients and healthy individuals into four subgroups, depending on the body weight, it was found that leukocytosis, neutrophilia, monocytosis, and the NLR index in patients with T2DM correlated with the BMI value. At BMI ≤ 25.5 kg/m2, the number of leukocytes in T2DM patients compared with those in healthy individuals was increased by 11.5 %, neutrophils by 20.7 % (p = 0.007), monocytes by 11.1 %, and the NLR index by 19.4 %. With a BMI of 25.9–29.9 kg/m2, the number of leukocytes was increased by 19.2 %, neutrophils by 27.6 %, monocytes by 38.8 %, and the NLR index by 29.7 %. With a BMI of 30.0–34.9 kg/m2, the number of leukocytes was significantly increased by 48.1 %, neutrophils by 58.6 %, monocytes by 105 %, and the index NLR by 32.6 %; and with BMI > 35 kg/m2, leukocytes were increased by 67.3 %, neutrophils by 93 %, monocytes by 97 %, and the index of inflammation NLR by 54.9 %. In healthy individuals, similar changes were observed depending on the leukocyte composition and BMI but less pronounced. Conclusions. The level of leukocytosis, neutrophilia, monocytosis, and the index of inflammation NLR in T2DM patients also largely depends on their body weight, especially obesity. In obesity, the inflammatory process is intensified by summing factors specific to the pathogenesis of T2DM and overweight, this must be taken into account when choosing therapy in patients with type 2 diabetes mellitus, complicated by obesity.

References

International Diabetes Federation (IDF). IDF Diabetes Atlas, 8th edition. Brussels, Belgium: IDF; 2017. 150 p.

American Diabetes Association. Standards of Medical Care in Diabetes-2020 Abridged for Primary Care Providers. Clin Diabetes. 2020 Jan;38(1):10-38. doi:10.2337/cd20-as01.

Tronko ND, Zak KP. Current advances in clinical pathophysiology in the study of the pathogenesis of type 1 and type 2 diabetes mellitus in humans. Mìžnarodnij endokrinologìčnij žurnal. 2019;15(6):422-434. doi:10.22141/2224-0721.15.6.2019.185403. (in Russian).

Donath MY. Multiple benefits of targeting inflammation in the treatment of type 2 diabetes. Diabetologia. 2016 Apr;59(4):679-82. doi:10.1007/s00125-016-3873-z.

Netea MG, Balkwill F, Chonchol M, et l. A guiding map for inflammation. Nat Immunol. 2017 Jul 19;18(8):826-831. doi:10.1038/ni.3790.

Pearson ER. Type 2 diabetes: a multifaceted disease. Diabetologia. 2019 Jul;62(7):1107-1112. doi:10.1007/s00125-019-4909-y.

Pollack RM, Donath MY, LeRoith D, Leibowitz G. Anti-inflammatory Agents in the Treatment of Diabetes and Its Vascular Complications. Diabetes Care. 2016 Aug;39 Suppl 2:S244-52. doi:10.2337/dcS15-3015.

Jiang G, Luk AO, Tam CHT, et al. Obesity, clinical, and genetic predictors for glycemic progression in Chinese patients with type 2 diabetes: A cohort study using the Hong Kong Diabetes Register and Hong Kong Diabetes Biobank. PLoS Med. 2020 Jul 28;17(7):e1003209. doi:10.1371/journal.pmed.1003209.

Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju ShN, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016 Aug 20;388(10046):776-86. doi:10.1016/S0140-6736(16)30175-1.

Nolan JJ, Færch K. Estimating insulin sensitivity and beta cell function: perspectives from the modern pandemics of obesity and type 2 diabetes. Diabetologia. 2012 Nov;55(11):2863-7. doi:10.1007/s00125-012-2684-0.

Ford ES. Leukocyte count, erythrocyte sedimentation rate, and diabetes incidence in a national sample of US adults. Am J Epidemiol. 2002 Jan 1;155(1):57-64. doi:10.1093/aje/155.1.57.

Shitole SG, Biggs ML, Reiner AP, et al. Soluble CD14 and CD14 Variants, Other Inflammatory Markers, and Glucose Dysregulation in Older Adults: The Cardiovascular Health Study. Diabetes Care. 2019 Nov;42(11):2075-2082. doi:10.2337/dc19-0723.

Wannamethee SG, Papacosta O, Lawlor DA, et al. Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women's Heart Health Study. Diabetologia. 2012 Jan;55(1):80-7. doi:10.1007/s00125-011-2284-4.

Muntner P, Shimbo D, Carey RM, et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension. 2019 May;73(5):e35-e66. doi:10.1161/HYP.0000000000000087.

Saienko YaA, Zak KP, Popova VV, Semionova TA. Leukocyte composition and immunophenotype of blood lymphocytes in women with type 2 diabetes mellitus with obesity. Mìžnarodnij endokrinologìčnij žurnal. 2016;5(77):13-19. doi:10.22141/2224-0721.5.77.2016.78748. (in Russian).

Scherer PE. The Multifaceted Roles of Adipose Tissue-Therapeutic Targets for Diabetes and Beyond: The 2015 Banting Lecture. Diabetes. 2016 Jun;65(6):1452-61. doi:10.2337/db16-0339.

Zhao S, Kusminski CM, Elmquist JK, Scherer PE. Leptin: Less Is More. Diabetes. 2020 May;69(5):823-829. doi:10.2337/dbi19-0018.

Cariou B, Hadjadj S, Wargny M, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020 Aug;63(8):1500-1515. doi:10.1007/s00125-020-05180-x.

Mauvais-Jarvis F. Aging, Male Sex, Obesity, and Metabolic Inflammation Create the Perfect Storm for COVID-19. Diabetes. 2020 Sep;69(9):1857-1863. doi:10.2337/dbi19-0023.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.

McGonagle D, Sharif K, O'Regan A, Bridgewood C. The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease. Autoimmun Rev. 2020 Jun;19(6):102537. doi:10.1016/j.autrev.2020.102537.

Mehta P, McAuley DF, Brown M,et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033-1034. doi:10.1016/S0140-6736(20)30628-0.

Published

2020-10-01

Issue

Section

Original Researches