EVALUATION OF MONOCYTE TO HIGH-DENSITY LIPOPROTEIN CHOLESTEROL RATIO AS A PREDICTIVE MARKER OF DIABETES MELLITUS SEVERITY IN OLDER PATIENTS

Year 2023, Volume: 86 Issue: 4, 288 - 294, 01.12.2023

Gülru Ulugerger Avcı , Derya Argun , Günay Can , Mehmet Fatih Kılıçlı

https://doi.org/10.26650/IUITFD.1295132

Abstract

Objective: Diabetes mellitus (DM) is a disease characterized by chronic hyperglycemia and inflammation, the frequency of which increases with age. The monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerging inflammatory biomarker associated with various diseases. We aimed to investigate the utility of the MHR as a clinically useful inflammation- based marker in determining the severity of DM in older patients.
Material and Method: We designed our study in a retrospective, cross-sectional structure. The participants were assessed for eligibility from the population aged over 60 years of diabetic patients who were admitted to the Istanbul Medipol University Hospital endocrinology outpatient clinic between September 1st 2022, and March 1st, 2023. Data were collected from electronic medical records. Age, gender, and laboratory findings were recorded.
Result: Overall, 148 older participants (70 females, 78 males, mean age 69.17±5.74 years) were included in the analysis. MHR, white blood cell, neutrophil, lymphocyte, and monocyte counts were higher, while high-density lipoprotein cholesterol (HDL-C) levels were lower in patients with inadequate glycemic control (HbA1c ≥7%) (p <0.001, for both of them). There was a moderately strong correlation between HbA1c and MHR (r = 0.611, p <0.001). Lower HDL-C ((OR = 0.88, (95% CI: 0.82–0.94), p < 0.001) (Model 1)) and higher MHR ((OR: 1.45, 95% CI: 1.27-1.65, p < 0.001) (Model 4)) were independently associated with increased HbA1c.
Conclusion: HDL-C and MHR were independent factors in predicting an increased HbA1c in older diabetic patients. Lower HDL-C levels had a more significant role in the severity of predicting increased HbA1c compared to the monocyte counts.

Keywords

Monocyte to high-density lipoprotein cholesterol ratio, inflammation, diabetes mellitus, HbA1c, older patient

MONOSİT / YÜKSEK YOĞUNLUKLU LİPOPROTEİN KOLESTEROL ORANININ YAŞLI HASTALARDA DİYABETİN ŞİDDETİNİN PREDİKTİF BİR BELİRTECİ OLARAK DEĞERLENDİRİLMESİ

Abstract

Amaç: Diabetes mellitus (DM), sıklığı yaşla birlikte artan, kronik hiperglisemi ve inflamasyon ile karakterize bir hastalıktır. Monosit/ yüksek yoğunluklu lipoprotein kolesterol oranı (MHR), çeşitli hastalıklarla ilişkili, son zamanlarda ortaya çıkan inflamatuar bir biyobelirteçtir. Yaşlı hastalarda DM'nin ciddiyetini belirlemede inflamasyona dayalı bir belirteç olan MHR'nin kullanımının faydasını araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmamızı retrospektif, kesitsel bir yapıda tasarladık. Araştırmanın populasyonu oluşturmak için, 01 Eylül 2022 - 01 Mart 2023 tarihleri arasında İstanbul Medipol Üniversitesi Hastanesi endokrinoloji polikliniğine başvuran 60 yaş üstü diyabetik hastalar uygunluk açısından değerlendirildi. Veriler elektronik tıbbi kayıtlardan toplandı. Yaş, cinsiyet ve laboratuvar bulguları kaydedildi.
Bulgular: Toplam 148 yaşlı katılımcı (70 kadın, 78 erkek, ortalama yaş 69,17±5,74 yıl) analize dahil edildi. Yetersiz glisemik kontrolü olan hastalarda (HbA1c ≥%7) MHR, lökosit, nötrofil, lenfosit, monosit sayıları daha yüksek iken, yüksek yoğunluklu lipoprotein kolesterol (HDL-C) düzeyleri daha düşük saptandı (p <0,001, her ikisi için de). HbA1c ve MHR arasında orta derecede güçlü bir korelasyon vardı (r = 0,611, p <0,001). Düşük HDL-C ((OR = 0,88, (%95 CI: 0,82–0,94), p<0,001) (Model 1)) ve yüksek MHR ((OR: 1,45, %95 CI: 1,27-1,65, p <0,001) (Model 4)) bağımsız olarak yüksek HbA1c değerleri ile ilişkili bulundu.
Sonuç: HDL-c ve MHR, diyabetik yaşlı hastalarda artmış HbA1c' yi öngörmede bağımsız faktörlerdi. Düşük HDL kolesterol düzeyleri, monosit sayılarına kıyasla artmış HbA1c'yi öngörme şiddetinde daha anlamlı bir role sahipti.

Keywords

Monosit/yüksek yoğunluklu lipoprotein oranı, inflamasyon, diabetes mellitus, HbA1c, yaşlı hasta

References

• Salive ME. Multimorbidity in older adults. Epidemiol Rev 2013;35:75-83. google scholar
• Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022;183:109119. google scholar
• Salas A, Acosta D, Ferri CP, Guerra M, Huang Y, Jacob KS, et al. The prevalence, correlates, detection and control of diabetes among older people in low and middle income countries. A 10/66 Dementia Research Group Population-Based Survey. PLoS One 2016;11(2):e0149616. google scholar
• American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018;41(5):917- 28. google scholar
• Heald AH, Stedman M, Davies M, Livingston M, Alshames R, Lunt M, et al. Estimating life years lost to diabetes: outcomes from analysis of National Diabetes Audit and Office of National Statistics data. Cardiovasc Endocrinol Metab 2020;9(4):183-5. google scholar
• Inzucchi SE. Diagnosis of diabetes. N Engl J Med 2013;368(2):193. google scholar
• Kolb H, Martin S. Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes. BMC Med 2017;15(1):131. google scholar
• Kaabi YA. Potential roles of anti-inflammatory plantderived bioactive compounds targeting inflammation in microvascular complications of diabetes. Molecules 2022;27(21):7352. google scholar
• Lontchi-Yimagou E, Sobngwi E, Matsha TE, Kengne AP. Diabetes mellitus and inflammation. Curr Diab Rep 2013;13(3):435-44. google scholar
• Domingueti CP, Dusse LM, Carvalho Md, de Sousa LP, Gomes KB, Fernandes AP. Diabetes mellitus: The linkage between oxidative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications 2016;30(4):738-45. google scholar
• Ammirati E, Moroni F, Magnoni M, Di Terlizzi S, Villa C, Sizzano F, et al. Circulating CD14+ and CD14highCD16- classical monocytes are reduced in patients with signs of plaque neovascularization in the carotid artery. Atherosclerosis 2016;255:171-8. google scholar
• Canpolat U, Çetin EH, Cetin S, Aydin S, Akboga MK, Yayla C, et al. Association of monocyte-to-HDL cholesterol ratio with slow coronary flow is linked to systemic inflammation. Clin Appl Thromb Hemost 2016;22(5):476-82. google scholar
• Onalan E. The relationship between monocyte to high-density lipoprotein cholesterol ratio and diabetic nephropathy. Pak J Med Sci 2019;35(4):1081-6. google scholar
• Karatas A, Turkmen E, Erdem E, Dugeroglu H, Kaya Y. Monocyte to high-density lipoprotein cholesterol ratio in patients with diabetes mellitus and diabetic nephropathy. Biomark Med 2018;12(9):953-9. google scholar
• Choi SH, Kim JH, Lim S, Lim JY, Kim KW, Park KS, Jang HC. Monocyte count as a predictor of cardiovascular mortality in older Korean people. Age Ageing 2017;46(3):433-8. google scholar
• Yang L, Hu J, Wang Z, Chen X, Wang Y, Yang S, et al. Peripheral monocyte count is an independent predictor of all-cause mortality in type 2 diabetes with macro-vascular complications. Medicine 2020;99(4):e18876. google scholar
• Amouzegar A, Mirzaasgari Z, Mehrabi A, Malek M, Alaei- Shahmiri F, Najafi L, Khajavi A. Association of monocyte/ high-density lipoprotein cholesterol ratio and the carotid intima-media thickness in diabetic patients. BMC Endocr Disord 2022;22(1):323 google scholar
• Jia J, Liu R, Wei W, Yu F, Yu X, Shen Y, et al. Monocyte to high-density lipoprotein cholesterol ratio at the nexus of type 2 diabetes mellitus patients with metabolic-associated fatty liver disease. Front Physiol 2021;12:762242. google scholar
• Chandran J, Wadhwa N, Madhu SV, Kumar R, Sharma S. Monocyte CD36 expression associates with atherosclerotic burden in diabetes mellitus. Diabetes Res Clin Pract 2020;163:108156. google scholar
• Min D, Nube V, Tao A, Yuan X, Williams PF, Brooks BA, et al. Monocyte phenotype as a predictive marker for wound healing in diabetes-related foot ulcers. J Diabetes Complications 2021;35(5):107889. google scholar
• Rye KA, Barter PJ. Cardioprotective functions of HDLs. J Lipid Res 2014;55(2):168-79. google scholar
• Gomes BF, Accardo CM. Immunoinflammatory mediators in the pathogenesis of diabetes mellitus. Einstein 2019;17(1):eRB4596. google scholar
• Cetin MS, Ozcan Cetin EH, Kalender E, Aydin S, Topaloglu S, Kisacik HL, et al. Monocyte to HDL cholesterol ratio predicts coronary artery disease severity and future major cardiovascular adverse events in acute coronary syndrome. Heart Lung Circ 2016;25(11):1077-86. google scholar
• Chen JW, Li C, Liu ZH, Shen Y, Ding FH, Shu XY, et al. The role of monocyte to high-density lipoprotein cholesterol ratio in prediction of carotid intima-media thickness in patients with type 2 diabetes. Front Endocrinol 2019;10:191. google scholar
• Kizilgul M, Sencar E, Bekir UC, Beysel S, Ozcelik O, Ozbek M, et al. Components of the complete blood count in type 2 diabetes mellitus with inadequate glycemic control. Dicle Tıp Dergisi 2018;45(2):113-20. google scholar
• You S, Zhong C, Zheng D, Xu J, Zhang X, Liu H, et al. Monocyte to HDL cholesterol ratio is associated with discharge and 3-month outcome in patients with acute intracerebral hemorrhage. J Neurol Sci 2017;372:157-61. google scholar
• Arısoy A, Altunkaş F, Karaman K, Karayakalı M, Çelik A, Ceyhan K, et al. Association of the monocyte to HDL cholesterol ratio with thrombus burden in patients with STsegment elevation myocardial infarction. Clin Appl Thromb Hemost 2017;23(8):992-7. google scholar
• Selvaggio S, Brugaletta G, Abate A, Musso C, Romano M, Di Raimondo D, et al. Platelettolymphocyte ratio, neutrophiltolymphocyte ratio and monocytetoHDL cholesterol ratio as markers of peripheral artery disease in elderly patients. Int J Mol Med 2020;46(3):1210-6. google scholar