Clinical Utility of Using Hematological Markers of Systemic Inflammation as Surrogate Markers for Glycated Hemoglobin in Resource-limited Settings – A Prospective Observational Study

BACKGROUND: Diabetes mellitus is a major global health problem with a disproportionately high burden in low- and middle-income countries, where access to glycated haemoglobin (HbA1c) testing remains limited. AIMS AND OBJECTIVES: The study aimed to assess the utility of basic haematological parameters such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as a surrogate marker for HbA1c. MATERIALS AND METHODS: This prospective cross-sectional study was conducted on 300 participants, divided into three equal groups based on their HbA1c levels (Group 1 with HbA1c between 5.7% and 6.4%, Group 2 with HbA1c >6.4%, and Group 3 with HbA1c <5.7). The relevant laboratory data for all three groups were retrieved from the patient records and statistically analyzed using analysis of variance. A receiver operating characteristic curve was plotted to analyze whether the value of these haematological parameters may be used to predict HbA1c levels. RESULTS AND CONCLUSIONS: The study concluded that a set of haematological parameters (NLR, PLR, absolute neutrophil count, absolute monocyte count, platelet count, systemic inflammatory response index, and systemic immune-inflammation index) is a significant associate of HbA1c and a potential surrogate marker for glycaemic control. The study also concluded that an NLR cutoff of 1.79 may be used as the value above which glycaemic control is suboptimal. In resource-limited settings, NLR may serve as a pragmatic adjunct marker for identifying suboptimal glycaemic control.