| BackgroundType 2 diabetes is a chronic metabolic disease that can affect the whole body.With the acceleration of urbanization,the aging of the population,the increasing prevalence of obesity and genetic susceptibility,the incidence of diabetes increased gradually.Diabetes mellitus has become an important disease endangering global public health.In the occur and development of diabetes,insulin resistance plays an important role.Insulin resistance mainly refers to the decreased sensitivity of skeletal muscle,liver,adipose tissue and other target organs to insulin,leading to disordered metabolism of carbohydrates,fats,proteins and other substances.In addition,studies have shown that insulin resistance is also related to other diseases which affect human health.In recent years,more attention has been paid to the relationship between inflammation and insulin resistance and type 2 diabetes.The neutrophil-lymphocyte ratio(NLR)is a recently proposed marker of inflammation with better stability.It reflects the body's inflammation state and has a good correlation with traditional inflammation indicators.Red blood cell distribution width(RDW)is an index obtained in the blood to assess the variability of red blood cell volume and size.It is mainly used for the differential diagnosis of anemia.Current research shows that RDW is associated with the inflammatory status of various diseases.Both NLR and RDW are routine examination items in the blood routine and are easy to obtain.At present,there are many studies on the relationship between NLR and RDW and diabetes,but there are few studies on the relationship between the two and insulin resistance in patients with type 2 diabetes.The purpose of this study was to explore the correlation between NLR and RDW levels and insulin resistance in patients with type 2 diabetes,so as to provide new possibilities for the diagnosis and treatment of diabetes.AimTo investigate the changes of NLR and RDW levels in patients with type 2 diabetes,and to explore the relationship between the two and insulin resistance.Patient Selection and methodsAccording to the inclusion and exclusion criteria,101 patients with type 2 diabetes who were newly diagnosed in the First Affiliated Hospital of Zhengzhou University from June 2019 to December 2019 were selected,and 55 healthy medical examiners in our hospital during the same period were selected.Collect basic data such as gender,age,height,weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),smoking history,drinking history,and family history of diabetes.The fasting venous blood was taken in the early morning of the second day for laboratory testing after 8 hours of fasting.The test items include white blood cell(WBC),neutrophil count(NC),and lymphocyte count(LC),neutrophil/lymphocyte ratio(NLR),fasting blood glucose(FBG),fasting insulin glucose(FINS),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C).Calculate body mass index(BMI),estimated glomerular filtration rate(eGFR)and homeostasis model assessment insulin resistance index(HOMA-IR).According to the insulin resistance index(HOMA-IR)value,the type 2 diabetes patients were divided into insulin resistance group(IR group,n=56 cases,HOMA-IR>26.9)and non-insulin resistance group(non-IR group,n=45 cases,HOMA-IR?26.9),the general data and test results of the two groups of patients include age,gender,history of smoking,history of alcohol consumption,family history of diabetes,systolic blood pressure,diastolic blood pressure,body mass Index,blood lipids,blood glucose,and blood routine parameters were compared,and binary logistic regression was used to analyze the correlation between NLR and RDW levels and insulin resistance in patients with type 2 diabetes.SPSS 26.0 software was used for data entry and statistical analysis.The measurement data of the two groups of measurement data is represented by mean ±standard deviation.Two independent sample t tests are used for the comparison between the groups and the chi-square test is used for the count data.Using Spearman for bivariate correlation analysis and use binary logistic regression to analyze the correlation between NLR and RDW levels and insulin resistance in patients with type 2 diabetes.All statistics were tested using a two-sided test.P<0.05 was considered statistically significant.Results1.Comparison of general data between T2DM group and control groupThe body mass index and diastolic blood pressure of the type 2 diabetes group were higher than control group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in gender,age,smoking history,drinking history,family history of diabetes,and systolic blood pressure(P>0.05).2.Comparison of laboratory indexes between T2DM group and control groupThere was no statistically significant difference between WBC,NC and HDL-C,between the T2DM group and the control group(P>0.05).NLR,RDW,TC,TG,LDL-C,FBP,FINS and HOMA-IR levels were higher than the control group,the difference was statistically significant(P<0.05).The levels of LC and eGFR in the T2DM group are lower than those in the control group,and the difference was statistically significant(P<0.05).3.Index comparison between IR group and non-IR groupThere was no significant difference in gender,age,smoking history,drinking history and family history between IR group and non-IR group(P>0.05);SBP,DBP,TC,HDL-C,HbAlc and FBP were not statistically significant between the two groups(P>0.05);BMI,NLR,RDW,TG,LDL-C and FBP levels in IR group were higher than those in non-IR group,and the difference was statistically significant(P<0.05).4.Spearman line correlation analysis between each indicator and HOMA-IRThe results showed that among patients with type 2 diabetes,BMI,NLR,RDW,TC,TG,FBG and HOMA-IR were positively correlated,and the correlation coefficients with HOMA-IR were(r=0.424,0.684,0.423,0.276,0.321,0.409,P<0.05),HDL-C was negatively correlated with HOMA-IR,the correlation coefficient was r=-0.205,P<0.05.There was no correlation between age,SBP,DBP,LDL-C,HbA1c and HOMA-IR(P>0.05).5.Logistic regression analysisBinary logistic regression analysis was performed using IR as the dependent variable and BMI,TG,LDL-C,NLR,RDW,and FBG as independent variables.The results show that BMI,TG,LDL-C,NLR,RDW,and FBG are the risk factors for insulin resistance in patients with type 2 diabetes.6.ROC working curveDraw the ROC curve with NLR as the independent variable and IR as the dependent variable.The results showed that the area under the ROC curve for NLR to predict the occurrence of insulin resistance was 0.814(95%CI:0.731-0.897,P<0.001),the best cut-off value was 1.85,and the sensitivity was 75.0%,and specificity was 77.8%.Draw the ROC curve with RDW as the independent variable and IR as the dependent variable.The results showed that the area under the ROC curve for predicting the occurrence of insulin resistance by RDW was 0.747(95%CI:0.654-0.841,P<0.001),the best cut-off value was 13.35,and the sensitivity was 46.4%,and the specificity was 88.9%.ConclusionNLR and RDW are associated with insulin resistance in type 2 diabetes mellitus and can be used as a predictor of insulin resistance. |
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