Neutrophil-to-Lymphocyte Ratio and Selected Hematological Parameters in Adults with Diabetes Mellitus: A Case-Control Study in Gezira State, Sudan

Ahmed Mohammed Elhassan Ahmed, Tanzeel Alamin Almahdi Gorashi*, Ruba Abd Alazeem Yonis Ahmed, Tanzil Hassan Khiar Fadlalmola, Alkhansa Fath Alrhman Ali Ahmed and Sara Nasreldeen Abdelrahman Mohammed

Background: Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia and a low-grade inflammatory state. The Neutrophil-to-Lymphocyte Ratio (NLR), calculated from routine complete blood count parameters, is an inexpensive and readily available inflammatory index that has been investigated as a marker of disease severity and complications.

Objective: To compare NLR and selected hematological parameters between adults with diabetes mellitus and healthy controls, and to examine the relationship of NLR with demographic characteristics, metabolic parameters, and hematological indices in Gezira State, Sudan.

Methods: A case–control study was conducted at Abo Aglaa Diabetic Center, Gezira State, Sudan, from April to September 2025. One hundred adults were enrolled, including 50 patients with diabetes mellitus (cases) and 50 apparently healthy controls. Three milliliters of venous blood were collected into EDTA tubes and analyzed for complete blood count using a Sysmex XP-300 automated hematology analyzer. Absolute Neutrophil Count (ANC), Absolute Lymphocyte Count (ALC), and NLR were obtained, and demographic and clinical information was collected using a structured questionnaire. All variables were analyzed as continuous measurements (age was recorded in categories and analyzed as an ordinal variable). Normality was assessed with the Shapiro–Wilk test; because at least one study group showed evidence of non-normality for each analyzed variable, non-parametric methods were used, and groups were compared using the Mann–Whitney U test (two groups) or the Kruskal–Wallis test (more than two groups), and associations were assessed using Spearman correlation. A two-sided p<0.05 was considered significant.

Results: Median ANC (3.74 vs 2.66 ×10³/µL, p=0.003) and ALC (2.84 vs 2.24 ×10³/µL, p=0.009) were higher in diabetic patients than in controls; however, these differences were confined to the 11 patients with type 1 diabetes and were not present when type 2 patients (n=39) were compared with controls (p=0.194 and p=0.406). NLR did not differ between diabetic patients and controls (median 1.15 [IQR 0.90–1.48] vs 1.12 [0.90–1.68]; U=1274.0, p=0.871). NLR was higher in participants with reported obesity than in those without (median 1.30 vs 1.10, p=0.015) but was not associated with age group (p=0.445), sex (p=0.487), education level (p=0.639), or chronic disease status (p=0.909). NLR was not correlated with fasting blood glucose, random blood sugar, or HbA1c in the total sample or in diabetic patients (all p>0.05). NLR correlated positively with ANC in the total sample (ρ=0.487, p<0.001) and in diabetic patients (ρ=0.464, p<0.001) and negatively with ALC in the total sample (ρ=−0.456, p<0.001).

Conclusion: NLR did not differ significantly between adults with diabetes and healthy controls, and it was not correlated with glycemic indices. Higher ANC and ALC in diabetic patients appeared to be driven by the small type 1 subgroup (n=11), whose values require verification. NLR may therefore be considered a supportive inflammatory marker rather than a standalone indicator of diabetes status or glycemic control in clinically stable patients. Larger studies including patients with different stages of disease and complications are warranted.

Keywords:

Published on: Oct 7, 2026 Pages: 24-30

Full Text PDF Full Text HTML DOI: 10.17352/gjodms.000072
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat