Relationship Between NLR Level And Insulin Resistance In Patients With Type 2 Diabetes Mellitus

Background and ObjectiveType 2 diabetes mellitus(T2DM)is a preventablesystemic metabolic disease,and its morbidity and mortality are increasing year by year.It is a global public health crisis,greatly increasing the economic expenses of the sick family and society.Insulin resistance is one of the main characteristics of T2DM,mainly occurring in skeletal muscle,liver,adipose tissue,heart and other organs with dense distribution of insulin receptors.The pathogenesis of T2DM is very complex and is not yet clear,but most studies have confirmed that chronic low-grade inflammatory response plays an indispensable role in T2DM.In the past few years,neutrophil-lymphocyte ratio(NLR),as a new inflammatory marker,has been introduced many times in cardio-related and non-related diseases.It is increased in both diabetes and insulin resistance,and is also associated with inflammation,inflammatory disease activity and anti-inflammatory treatment response.NLR level not only reflects the relative changes of non-specific inflammatory mediators neutrophils and inflammatory protective or regulatory components lymphocytes,but also has the characteristics of being less affected by various physiological and pathological states,better stability,easy access and low price compared with independent inflammatory cell count.The purpose of this study was to explore the correlation between NLR level and insulin resistance,so as to provide new possibilities for the diagnosis and treatment of diabetes.MethodsIn this study,a total of 198 newly diagnosed type 2 diabetes patients(T2DM group),male/female(125/73),aged(23-75),who met the diagnostic criteria for DM were included.In addition,88 healthy subjects at the same period in our hospital were selected as the control group,male/female(57/31),aged(20-72).Taking homa-ir value=2.69 as the dividing line of insulin resistance,T2DM subjects were divided into two groups,namely non-ir group(Homa IR 2.69)and IR group(Homa IR>2.69).All per capita complete medical history collection,general information as well as fasting and postprandial blood glucose determination three times total peripheral blood fasting plasma glucose(FPG),fasting insulin(FINS),fasting C peptide(FCP),white blood cell count(WBC),neutrophil count(NC),lymphocyte count(LC)and mononuclear cell count(MC),glycosylated hemoglobin(HbA1c),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),total cholesterol(TC),triglyceride(TG).Results1.T2DM group and healthy control group:gender,age,smoking history,drinking history,height,weight,systolic blood pressure,diastolic blood pressure,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol and monocyte count between the two groups were not statistically significant(P>0.05);The probability of family history,BMI,triglycerides,white blood cell count,neutrophil count,neutrophil/lymphocyte ratio,fasting blood glucose,glycosylated hemoglobin and islet resistance index were increased in the T2DM group.Lymphocyte count decreased,and the difference was statistically significant(P<0.05).2.There was no significant difference in gender,age,smoking history,drinking history,family history,blood pressure,total cholesterol,high-density lipoprotein cholesterol,glycosylated hemoglobin and fasting blood glucose between the two groups in the IR group and the non-ir group.BMI,NLR,TG and ldl-c of the resistance group all increased to varying degrees,and the difference was statistically significant(P<0.05).3.Taking the presence or absence of insulin resistance as the dependent variable and correcting the factors with differences before,binary Logistic regression analysis was conducted.The analysis results showed that NLR,BMI and TG were independent risk factors of insulin resistance.4.The linear continuous value of NLR in T2DM group was used as the independent variable,and the dependent variable was defined as insulin resistance to draw the subject’s working characteristic curve.Statistics show that the area surrounding X and Y axis under the ROC curve=0.770(95%ci:0.660-0.880,P=0.000),the best critical value is NLR=1.715,and the sensitivity and specificity are 76.7%and 44.6%respectively when NLR=1.715.Conclusion1.NLR is significantly correlated with insulin resistance and is an independent risk factor for insulin resistance.2.NLR has a predictive effect on insulin resistance with a certain accuracy,and the best predictive value is NLR=1.715.