Hematological Harbingers: Exploring the Neutrophil - to - Lymphocyte and Platelet - to - Lymphocyte Ratios as Novel Biomarkers for Diabetic Neuropathy

Diabetic neuropathy is a prevalent and debilitating complication of diabetes mellitus. This review explores the potential of two hematological markers, the Neutrophil -to -Lymphocyte Ratio (NLR) and Platelet -to -Lymphocyte Ratio (PLR), as novel biomarkers for diabetic neuropathy. Recent studies have shown significant associations between elevated NLR and PLR values and the presence and severity of diabetic neuropathy in both type 1 and type 2 diabetes. These ratios reflect underlying chronic inflammation and immune dysregulation characteristic of diabetes and its complications. Proposed cut -off values for NLR range from 1.7 to 4.3, while PLR cut -off values ranging from 92 to 120 have been suggested, with varying sensitivities and specificities across studies. The mechanisms linking these ratios to diabetic neuropathy involve complex interactions between inflammation, oxidative stress, and vascular dysfunction. While the evidence is promising, challenges remain, including the need for standardization of cut -off values, consideration of confounding factors, and longitudinal studies to establish causality. Despite these limitations, NLR and PLR show potential as simple, cost -effective tools for early screening, risk stratification, and monitoring of diabetic neuropathy progression. Their use as complementary markers alongside established tests could improve the accuracy of neuropathy prediction and guide personalized treatment strategies. Further research, particularly large -scale longitudinal studies and standardization efforts, is needed to fully establish the clinical utility of NLR and PLR in the context of diabetic neuropathy management.