Can inflammatory blood markers reflect presentation type and cumulative glycemic control status in childhood-onset type 1 diabetes?

Authors : Meliha Esra Bilici
Pages : 423-431
Doi:10.29058/mjwbs.1811255
View : 28 | Download : 51
Publication Date : 2025-12-31
Article Type : Research Paper
Abstract :Aim: Type 1 diabetes mellitus (T1DM) is the most common form of childhood diabetes and involves autoimmune β-cell destruction associated with systemic inflammation. This study aimed to evaluate the potential of inflammatory hematological indices (SII, SIRI, NLR, PLR) to indicate presentation type and long-term glycemic control in childhood- onset T1DM. Material and Methods: A longitudinal cohort study was conducted on children aged 2-18 years with T1DM and along with age- and sexmatched healthy controls, recruited between April 2021 and June 2024. At diagnosis, patients were categorized according to clinical presentation as diabetic ketoacidosis (DKA), ketosis without acidosis, or isolated hyperglycemia. Hematological inflammatory parameters (SII, SIRI, NLR, PIV, PDW, PCT, MPV) were measured at diagnosis and one-year follow- up. Mean HbA1c values obtained over the one-year follow-up period, excluding those from initial presentation, were used to assess cumulative glycemic control. Based on these values, patients were categorized into good ( 9%) metabolic control groups. Results: A total of 137 participants (mean age 10,4±4,1 years; %51,1 female (n: 67)] were included. Among T1DM patients, 57.8% presented with DKA. Seventy-seven children with T1DM and 60 healthy controls were included. Among the patients, 57.8% presented with DKA, 26.0% with diabetic ketosis, and 16.2% with isolated hyperglycemia. At diagnosis, neutrophil and leukocyte counts, as well as SII, SIRI, NLR, and PLR, were significantly higher in the DKA group than in the other subgroups and controls (p<0.001). Inflammatory markers were not useful in distinguishing metabolic control categories during follow-up, and no correlation was found between cumulative HbA1c and inflammatory indices at one year. In the ROC analysis, SII (AUC = 0.793; 95% CI: 0.685–0.901) and SIRI (AUC = 0.780; 95% CI: 0.668–0.893) demonstrated the highest diagnostic performance in distinguishing DKA; their optimal cut-off values were 614.9 (sensitivity 76.9%, specificity 75.9%) and 0.95 (sensitivity 85.4%, specificity 65.5%), respectively. Conclusion: Inflammatory blood markers, particularly SII and SIRI, appear to be valuable in identifying DKA at T1DM onset but not in predicting long-term metabolic control.
Keywords : Tip 1 diyabetes mellitus, glisemik kontrol, hematolojik inflamasyon indeksi, nötrofil-lenfosit oranı, sistemik immün inflamasyon indeksi

ORIGINAL ARTICLE URL