Assessment of white blood cell distribution as a prognostic factor in type 2 diabetes mellitus and its complications - literature overview
Abstract
Type 2 diabetes (T2DM) mellitus is the chronic, low-grade inflammatory disorder, which is considered to be the leading cause of morbidity and mortality worldwide. Wherefore, it is indispensable to look for new, non-invasive and widely available markers that will allow for early detection of predisposition to the development of diabetes as well as its macro- and microvascular complications.
Aim of the study:
The aim of our study was to present the role of white blood cells (WBC) count as a prognostic factor in type 2 diabetes mellitus. Moreover, we discussed the perspectives for the usefulness of WBC subtypes and neutrophil to lymphocyte ratio (NLR) as a marker of glycemic control as well as an indicator of the risk of developing diabetes complications.
Description of knowledge:
The abundant number of previous studies revealed that the elevated level of total WBC count strongly correlates with the predisposition to prediabetes and T2DM development. There is also association between the insulin resistance as well as the function and mass of beta-cells. The numerous research confirm that the increase in NLR may be the useful laboratory tool to evaluate the glycemic control and the effectiveness of antidiabetic treatment. NLR ratio as a marker, which directly reflects the level of inflammation is considered to indicate the risk of development of cardiovascular complications, diabetic peripheral neuropathy or nephropathy, even in the early stage of T2DM duration.
Conclusions:
Measurements of WBC count and changes in the number of subpopulations of them seem to be a useful, widely accessible marker of development of T2DM as well as its complications and may be helpful in management of T2DM patients.
Keywords
Full Text:
PDFReferences
Diabetes Canada Clinical Practice Guidelines Expert Committee, Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018; 42 Suppl 1:S10-S15. doi: 10.1016/j.jcjd.2017.10.003.
Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine. 2014; 42:698–702. doi: 10.1016/j.mpmed.2014.09.007.
Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011; 11(2):98-107. doi: 10.1038/nri2925.
Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest. 2003; 112(12):1821-1830. doi: 10.1172/JCI19451.
Pradhan, AD, Manson JE, Rifai N, Buring JE, Ridker. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001; 286: 327–334. PMID: 11466099.
Gkrania-Klotsas E, Ye Z, Cooper AJ, Sharp SJ, Luben R, Biggs ML et al. Differential white blood cell count and type 2 diabetes: systematic review and meta-analysis of cross-sectional and prospective studies. PLoS One. 2010; 5(10):e13405. doi: 10.1371/journal.pone.0013405.
Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012; 5(1):2. doi: 10.1186/1755-7682-5-2.
Sefil F, Ulutas KT, Dokuyucu R, Sumbul AT, Yengil E, Yagiz AE, et al. Investigation of neutrophil lymphocyte ratio and blood glucose regulation in patients with type 2 diabetes mellitus. J Int Med Res. 2014; 42(2):581-588. doi: 10.1177/0300060513516944.
Tong PC, Lee KF, So WY, Ng MH, Chan WB, Lo MK, et al. White blood cell count is associated with macro- and microvascular complications in chinese patients with type 2 diabetes. Diabetes Care. 2004; 27(1):216-222. PMID: 14693992.
Eftekharian MM, Karimi J, Safe M, Sadeghian A, Borzooei S, Siahpoushi E. Investigation of the correlation between some immune system and biochemical indicators in patients with type 2 diabetes. Hum Antibodies. 2016; 24(1-2):25-31. doi: 10.3233/HAB-150290.
Gu Y, Hu K, Huang Y, Zhang Q, Liu L, Meng G, et al. White blood cells count as an indicator to identify whether obesity leads to increased risk of type 2 diabetes. Diabetes Res Clin Pract. 2018; 141:140-147. doi: 10.1016/j.diabres.2018.04.041.
Borné Y, Smith JG, Nilsson PM, Melander O, Hedblad B, Engström G. Total and Differential Leukocyte Counts in Relation to Incidence of Diabetes Mellitus: A Prospective Population-Based Cohort Study. PLoS One. 2016; 11(2):e0148963. doi: 10.1371/journal.pone.0148963.
Twig G, Afek A, Shamiss A, Derazne E, Tzur D, Gordon B, et al. White blood cells count and incidence of type 2 diabetes in young men. Diabetes Care. 2013; 36(2):276-282. doi: 10.2337/dc11-2298.
Zhang H, Yang Z, Zhang W, Niu Y, Li X, Qin L, et al. White blood cell subtypes and risk of type 2 diabetes. J Diabetes Complications. 2017; 31(1):31-37. doi: 10.1016/j.jdiacomp.2016.10.029.
Kim JK, Lee AY, Kang JH, Yu BY, Kim SJ. Association of Fasting Glucose Level with Neutrophil-Lymphocyte Ratio Compared to Leukocyte Count and Serum C-Reactive Protein. Korean J Fam Med. 2018; 39(1):42-50. doi: 10.4082/kjfm.2018.39.1.42.
Lee CT, Harris SB, Retnakaran R, Gerstein HC, Perkins BA, Zinman B, et al. White blood cell subtypes, insulin resistance and β-cell dysfunction in high-risk individuals - the PROMISE cohort. Clin Endocrinol (Oxf). 2014; 81(4):536-541. doi: 10.1111/cen.12390.
Benhalima K, Standl E, Mathieu C. The importance of glycemic control: how low should we go with HbA1c? Start early, go safe, go low. J Diabetes Complications. 2011; 25(3):202-207. doi: 10.1016/j.jdiacomp.2010.03.002.
Gillett MJ. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: diabetes care 2009;32(7):1327-1334. Clin Biochem Rev 2009;30:197-200. PMCID: PMC2791773.
Biadgo B, Melku M, Abebe SM, Abebe M. Hematological indices and their correlation with fasting blood glucose level and anthropometric measurements in type 2 diabetes mellitus patients in Gondar, Northwest Ethiopia. Diabetes Metab Syndr Obes. 2016; 9:91-99. doi: 10.2147/DMSO.S97563.
Ali F, Alsayegh F, Sharma P, Waheedi M, Bayoud T, Alrefai F. White blood cell subpopulation changes and prevalence of neutropenia among Arab diabetic patients attending Dasman Diabetes Institute in Kuwait. PLoS One. 2018; 13(3):e0193920. doi: 10.1371/journal.pone.0193920.
Xu W, Wu HF, Ma SG, Bai F, Hu W, Jin Y, et al. Correlation between peripheral white blood cell counts and hyperglycemic emergencies. Int J Med Sci. 2013; 10(6):758-765. doi: 10.7150/ijms.6155.
Hussain M, Babar MZM, Akhtar L, Hussain MS. Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in type 2 diabetic patients. Pak J Med Sci. 2017; 33(6):1366-1370. doi: 10.12669/pjms.336.12900.
Chang FY, Shaio MF. Decreased cell-mediated immunity in patients with non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1995; 28(2):137-146. PMID: 7587921.
DeBoer MD. Obesity, systemic inflammation, and increased risk for cardiovascular disease and diabetes among adolescents: a need for screening tools to target interventions. Nutrition. 2013; 29(2):379-386. doi: 10.1016/j.nut.2012.07.003.
Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011; 107(3):433-438. doi: 10.1016/j.amjcard.2010.09.039.
Giugliano D, Acampora R, De Rosa N, Quatraro A, De Angelis L, Ceriello A, et al. Coronary artery disease in type-2 diabetes mellitus: a scintigraphic study. Diabete Metab. 1993; 19(5):463-466. PMID: 8056127.
Di Bonito P, Pacifico L, Chiesa C, Invitti C, Miraglia Del Giudice E, Baroni MG, et al. White blood cell count may identify abnormal cardiometabolic phenotype and preclinical organ damage in overweight/obese children. Nutr Metab Cardiovasc Dis. 2016; 26(6):502-509. doi: 10.1016/j.numecd.2016.01.013.
Sung KC, Ryu S, Sung JW, Kim YB, Won YS, Cho DS, et al. Inflammation in the Prediction of Type 2 Diabetes and Hypertension in Healthy Adults. Arch Med Res. 2017; 48(6):535-545. doi: 10.1016/j.arcmed.2017.11.010.
Xiao X, Ma B, Dong B, Zhao P, Tai N, Chen L, et al. Cellular and humoral immune responses in the early stages of diabetic nephropathy in NOD mice. J Autoimmun. 2009; 32(2):85-93. doi: 10.1016/j.jaut.2008.12.003.
Nakhjavani M, Aghajani Nargesi A, Salabati M, Mahmoudzadeh R, Morteza A, Heidari B, et al. Changes in leukocyte subpopulations with decline in glomerular filtration rate in patients with type 2 diabetes. Acta Med Iran. 2015; 53(7):425-431. PMID: 26520630.
Fan F, Jia J, Li J, Huo Y, Zhang Y. White blood cell count predicts the odds of kidney function decline in a Chinese community-based population. BMC Nephrol. 2017; 18(1):190. doi: 10.1186/s12882-017-0608-4.
Fukui M, Tanaka M, Hamaguchi M, Senmaru T, Sakabe K, Shiraishi E, et al. Eosinophil count is positively correlated with albumin excretion rate in men with type 2 diabetes. Clin J Am Soc Nephrol. 2009; 4(11):1761-1765. doi: 10.2215/CJN.03330509.
Khandare SA, Chittawar S, Nahar N, Dubey TN, Qureshi Z. Study of Neutrophil-lymphocyte Ratio as Novel Marker for Diabetic Nephropathy in Type 2 Diabetes. Indian J Endocrinol Metab. 2017; 21(3):387-392. doi: 10.4103/ijem.IJEM_476_16.
Sato H, Takeuchi Y, Matsuda K, Kagaya S, Saito A, Fukami H, et al. Pre-Dialysis Neutrophil-Lymphocyte Ratio, a Novel and Strong Short-Term Predictor of All-Cause Mortality in Patients With Diabetic Nephropathy: Results From a Single-Center Study. Ther Apher Dial. 2017; 21(4):370-377. doi: 10.1111/1744-9987.12533.
Wheelock KM, Saulnier PJ, Tanamas SK, Vijayakumar P, Weil EJ, Looker HC, et al. White blood cell fractions correlate with lesions of diabetic kidney disease and predict loss of kidney function in Type 2 diabetes. Nephrol Dial Transplant. 2018; 33(6):1001-1009. doi: 10.1093/ndt/gfx231.
Dyck PJ, Albers JW, Andersen H, Arezzo JC, Biessels GJ, Bril V, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011; 27(7):620-628. doi: 10.1002/dmrr.1226.
Liu S, Zheng H, Zhu X, Mao F, Zhang S, Shi H, et al. Neutrophil-to-lymphocyte ratio is associated with diabetic peripheral neuropathy in type 2 diabetes patients. Diabetes Res Clin Pract. 2017; 130:90-1397. doi: 10.1016/j.diabres.2017.05.008.
Xu T, Weng Z, Pei C, Yu S, Chen Y, Guo W, et al. The relationship between neutrophil-to-lymphocyte ratio and diabetic peripheral neuropathy in Type 2 diabetes mellitus. Medicine (Baltimore). 2017; 96(45):e8289. doi: 10.1097/MD.0000000000008289.
DOI: http://dx.doi.org/10.5281/zenodo.1345823
Refbacks
- There are currently no refbacks.
Copyright (c) 2018 © The Authors

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Journal of Education, Health and Sport formerly Journal of Health Sciences
Declaration on the original version.
Editors indicates that the main version of the magazine is to issue a "electronic".
The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.
1223 Journal of Education, Health and Sport eISSN 2391-8306 7
ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X
Archives 2011 - 2014
PBN 2011 - 2014
https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616
POL-index 2011 - 2014
https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655
BASE 2011 - 2014
http://elibrary.ru/contents.asp?titleid=37467
http://journal.rsw.edu.pl/index.php/JHS/issue/archive
Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska
US NLM = 101679844
101679844 - NLM Catalog Result - NCBI
https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844
Find a library that holds this journal: http://worldcat.org/issn/23918306
Journal Language(s): English
PBN Poland
https://pbn.nauka.gov.pl/sedno-webapp/journals/49068
POL-index
https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4
BASE
Redaction, Publisher and Editorial Office
Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2 www.ukw.edu.pl Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy http://ojs.ukw.edu.pl/index.php/johs Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X
The journal has been approved for inclusion in ERIH PLUS.
The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984
SIC Science citation index (calculated on the basis of TCI and Page Rank) 0
Russian Impact factor 0.16
Indexed in Index Copernicus Journals Master List.
http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html
ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 2011: 5.48
The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase Index.com.
Website: www.infobaseindex.com
Universal Impact Factor 1.78 for year 2012. (http://www.uifactor.org/AppliedJournals.aspx)
Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)
is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.
Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467
Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski
(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)