Neutrophil-Lymphocyte Ratio and Urine Albumin-Creatinine Ratio As Indicators of Microvascular Complications in Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Background Type 2 diabetes mellitus (T2DM) is associated with a high risk of developing microvascular complications such as diabetic nephropathy, diabetic neuropathy (DN), and diabetic retinopathy (DR), leading to significant morbidity. Early detection of these complications is crucial for improving patient outcomes. Neutrophil-lymphocyte ratio (NLR) and urine albumin-creatinine ratio (UACR) show promise as cost-effective and accessible biomarkers for the early detection of microvascular complications in T2DM. Their integration into routine care could enhance risk stratification, facilitate timely interventions, and improve patient outcomes, reducing the burden of diabetes-related morbidity. However, their clinical utility in diabetic populations remains underexplored.  Objective The study aims to evaluate the predictive value of NLR and UACR for microvascular complications, specifically DN and DR, in patients with T2DM. Methods This cross-sectional study included 130 patients diagnosed with T2DM undergoing routine investigations at the Department of General Medicine, Kempegowda Institute of Medical Sciences, Bengaluru. NLR and UACR, along with other secondary variables were measured, and their associations with DN and DR were analysed using various statistical tests to assess the viability of these biomarkers in predicting microvascular complications in clinical practice. Results UACR emerged as a strong predictor for both DR and DN. UACR achieved an accuracy of 91% for DR (area under the curve (AUC) 0.97) and 81.5% for DN (AUC 0.90). NLR showed 85% accuracy for DR (AUC 0.87) and 75% accuracy for DN (AUC 0.851). However, NLR was not a significant predictor in multivariate analyses, suggesting that other variables may affect its predictive ability. Logistic regression analyses identified UACR, duration of diabetes, and glycosylated haemoglobin (HbA1C) as significant predictors of microvascular complications. The models had adjusted R² values of 0.751 for DN and 0.881 for DR. Conclusion The study highlights the predictive value of NLR and UACR in detecting microvascular complications, particularly DN and DR, in patients with T2DM. UACR demonstrated superior utility compared to NLR, underscoring its clinical relevance in early screening for complications. Additionally, glycaemic control and diabetes duration were significant predictors, emphasising the importance of comprehensive monitoring in preventing diabetic complications. Further research is warranted to explore the role of NLR in larger, more diverse populations.