Abstract
Purpose. Systemic inflammation plays a pivotal role in the pathogenesis of type 2 diabetes mellitus (DM). The purpose of this study was to examine the relationship between glycated hemoglobin (HbA1c) levels and counts/ratios of circulating immune cells.
Methods. A laboratory database was subjected to analysis, encompassing complete blood count (CBC) and HbA1c values of 756 individuals. Student’s t and Pearson’s r criteria were used for statistical processing.
Results. HbA1c levels were significantly positively correlated with the erythrocyte sedimentation rate (ESR), total leukocyte count, neutrophil and lymphocyte counts, and negatively correlated with platelet-to-leukocyte ratio (PLeR), platelet-to-neutrophil ratio (PNR), and platelet-to-lymphocyte ratio (PLyR). According to HbA1c levels, the examined subjects were divided into three groups: group 1, less than 5.7%, normal levels (n=431); group 2, from 5.7% to 6.4%, levels of prediabetic state (n=166); group 3, 6.5% and above, levels of DM (n=159). In groups 2 and 3, in comparison with group 1, there were higher ESR (12.50±10.99 mm/h and 14.50±12.22 mm/h vs. 10.48±9.80 mm/h), counts of leukocytes [(7.01±2.10)×109/L and (7.33±2.48)×109/L vs. (6.45±1.98)×109/L, respectively], neutrophils [(4.40±1.98)×109/L and (4.42±2.22)×109/L vs. (3.81±1.71)×109/L, respectively], and monocytes [(0.47±0.25)×109/L and (0.46±0.25)×109/L vs. (0,41±0,21)×109/л, respectively] (p<0.05). In group 3, the lymphocyte count was higher than in group 1 [(2.29±0.77)×109/L versus (2.05±0.72)×109/L, respectively, p=0.001]. Furthermore, the PLeR and PLyR were lower than in group 2 (p=0.015 and p=0.026, respectively).
Discussion of results. With an increase in HbA1c to the level of prediabetes and DM, features of systemic inflammation increase, as evidenced by an increase in ESR and counts of immune cells and a decrease in the ratios between platelet and leukocyte, neutrophil, and lymphocyte counts. Groups of individuals with HbA1c levels that met the criteria for prediabetes and DM did not differ among themselves in most CBC parameters. This finding suggests a pivotal role of systemic inflammation in the progression to DM during the prediabetic state.
Conclusions. The rise in HbA1c levels has been observed to coincide with an increase in counts of circulating immune cells and a decrease in ratios of platelet to leucocyte, neutrophil, and lymphocyte counts. Low-grade systemic inflammation accompanies HbA1c levels of 5.7% and above.