Open AccessVitamin D affects the neutrophil‐to‐lymphocyte ratio in patients with type 2 diabetes mellitus
Author(s) -
Wang SiYang,
Shen TingTing,
Xi BeiLi,
Shen Zhan,
Zhang Xian
Publication year - 2021
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.13338
Subject(s) - medicine , prediabetes , diabetes mellitus , glycated hemoglobin , type 2 diabetes mellitus , neutrophil to lymphocyte ratio , type 2 diabetes , gastroenterology , lymphocyte , immunology , endocrinology
Aims/Introduction Chronic inflammation is an underlying feature of type 2 diabetes mellitus. Hypovitaminosis D is associated with type 2 diabetes mellitus, but whether it contributes to chronic inflammation is unclear. We examined the effects of vitamin D on various immune markers to evaluate its contribution to systemic inflammation in type 2 diabetes mellitus. Materials and Methods We retrospectively analyzed data from type 2 diabetes mellitus patients, people with prediabetes and control patients without diabetes ( n = 9,746). Demographic and clinical variables were evaluated using descriptive statistics and generalized linear regression. A stratified analysis based on total serum vitamin D was also carried out. Results Neutrophil count was a significant predictor of 1,5‐anhydroglucitol and glycated hemoglobin (HbA1c) in patients with prediabetes (1,5‐anhydroglucitol: β = −0.719, P < 0.001 and HbA1c: β = −0.006, P = 0.002) and patients with diabetes (1,5‐anhydroglucitol: β = 0.207, P = 0.004 and HbA1c: β = −0.067, P = 0.010). Lymphocyte count was a significant predictor of HbA1c in patients without diabetes (β = 0.056, P < 0.001) and patients with prediabetes (β = 0.038, P < 0.001). The neutrophil‐to‐lymphocyte ratio (NLR) was a significant predictor of HbA1c in patients without diabetes (β = −0.001, P = 0.032). No immune markers differed significantly based on vitamin D level among patients without diabetes ( P > 0.05 for all). Among patients with prediabetes, those who were vitamin D‐deficient had the highest NLR ( P = 0.040). Among patients with diabetes, those who were vitamin D‐deficient had the highest neutrophil count ( P = 0.001), lowest lymphocyte count ( P = 0.016) and highest NLR ( P < 0.001). Conclusions The NLR is strongly influenced by serum vitamin D level. Given the high prevalence of hypovitaminosis D and elevated NLR among chronic disease patients and the elderly, our results suggest that clinical interpretation of NLR as a predictive marker of type 2 diabetes mellitus‐related inflammation should consider vitamin D level, age and pre‐existing morbidity.