Baseline neutrophil-to-lymphocyte ratio is associated with long-term T2D remission after metabolic surgery

AimsMetabolic surgery is considered as a therapeutic option for obese patients with type 2 diabetes (T2D). In order to identify novel laboratory variables that could improve the selection of patients who might greatly benefit from a surgical approach, we focused on the neutrophil-to-lymphocyte ratio (NLR) as a predictor of long-term T2D remission following metabolic surgery.MethodsThirty-one obese patients with T2D included in this pilot study underwent Roux-en-Y gastric bypass or biliopancreatic diversion (BPD) at the Surgical Department of Genoa University, IRCCS Ospedale Policlinico San Martino in Genoa (Italy). Before surgery, serum samples were collected to evaluate blood count, glycemic profile, and circulating neutrophil degranulation products.ResultsThe median age was 56years, median body mass index (BMI) was 32.37kg/m(2), and median glycated hemoglobin was 8.4%. White blood cell count was in a range of normality, with a median NLR of 1.97. By a receiver operating characteristic curve analysis, NLR has been found to be significantly associated with T2D remission at 1, 3, and 5years and the best cutoff of1.97 has been identified by Youden index. When comparing study groups according to NLR cutoff, those with NLR1.97 were older and underwent more often BPD. By a logistic regression analysis, NLR1.97 has been found to predict T2D remission across 5years, irrespective of baseline BMI.ConclusionsA baseline low NLR is associated with long-term T2D remission in obese patients undergoing metabolic surgery, suggesting that circulating inflammatory cells (i.e., neutrophils) might negatively impact on T2D remission.