September 12, 2025

Inflammatory footprints: Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as novel biomarkers for diabetic peripheral neuropathy

RGRahul GargSarojini Naidu Medical College ATAnmol ThakreSarojini Naidu Medical College

Key Points

Patients with diabetic peripheral neuropathy show significantly higher NLR and PLR levels compared to those without.
The study included 306 patients with type 2 diabetes, demonstrating strong correlations between NLR, PLR and neuropathy severity.
Using comprehensive examinations, both NLR and PLR were identified as promising biomarkers for earlier detection of diabetic complications.
Integration of these inflammatory markers into diabetes care could significantly improve patient outcomes and monitoring.

Abstract

Objectives: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of diabetes mellitus, affecting approximately 50% of patients over the course of their disease. Early detection and management are essential for improving patient outcomes. This study investigates the potential of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as novel, cost-effective biomarkers for the detection and assessment of diabetic neuropathy in type 2 diabetes. Material and Methods: In this prospective observational study, 306 patients with type 2 diabetes mellitus were evaluated for peripheral neuropathy using detailed neurological examination, nerve conduction studies, Michigan neuropathy screening instrument, and vibration perception threshold testing. Complete blood counts were analyzed to calculate NLR and PLR values. Patients were categorized into DPN-positive and DPN-negative groups based on comprehensive neuropathy assessment criteria. Results: The DPN-positive group demonstrated significantly higher NLR (3.42 ± 1.15 vs. 2.18 ± 0.87, P < 0.001) and PLR (172.6 ± 45.3 vs. 138.4 ± 36.7, P < 0.001) compared to the DPN-negative group. Strong positive correlation was observed between NLR and DPN severity ( r = 0.624), while PLR showed moderate positive correlations ( r = 0.412). Both markers also showed significant associations with glycated hemoglobin levels. The pathophysiological mechanisms linking these ratios to diabetic neuropathy involve complex interactions between chronic inflammation, oxidative stress, immune dysregulation, and microvascular dysfunction. Conclusion: NLR and PLR represent promising, accessible, and cost-effective tools for detecting and monitoring DPN. These inflammatory markers could enhance early screening, risk stratification, and monitoring of disease progression. Their integration into routine diabetes care might improve the timely identification of patients at risk of developing this debilitating complication.

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