Type 2 diabetes mellitus (T2DM) remains a global health challenge, with over 537 million adults affected worldwide. By 2045, this number is projected to rise to 783 million. The condition is known to cause significant complications, especially in cardiovascular health. Recently, there has been growing interest in how diet and immune system function contribute to T2DM remission, particularly in patients with coronary heart disease (CHD). This study delves into the relationship between neutrophil count and T2DM remission, focusing on two common diets—Mediterranean and low-fat diets—among newly diagnosed T2DM patients.
Study Overview: Methodology and Participant Details
The CORDIOPREV study provided the foundation for this investigation, including 183 newly diagnosed T2DM patients with CHD who were not undergoing glucose-lowering treatment. The participants were randomly assigned to follow either a Mediterranean diet or a low-fat diet. After 5 years, the patients were divided into two groups: Responders, who achieved T2DM remission (73 patients), and Non-Responders (110 patients), who did not achieve remission. Neutrophil count and related ratios (NER, NBR, NLR, NHR) were measured both at the start and after 5 years of the dietary intervention.
Key Findings: Neutrophil Count Predicts T2DM Remission
Neutrophil Count and Its Impact on Remission
The study revealed that lower neutrophil counts at baseline were associated with a higher likelihood of achieving T2DM remission for patients following a Mediterranean diet. Specifically, those in the lowest tertile of neutrophil count were more likely to experience remission, with an adjusted hazard ratio (HR) of 4.23 compared to those in the highest tertile. This trend was also evident when considering neutrophil-related ratios, such as NER and NHR. In contrast, a similar effect was not observed in the low-fat diet group.
Predictive Capacity and Changes Over Time
A model that combined clinical and neutrophil variables demonstrated strong predictive ability for T2DM remission, with an area under the curve (AUC) of 0.783. Notably, after 5 years, Responders showed significantly lower neutrophil counts than Non-Responders (p = 0.006), along with a notable decrease in neutrophil count from baseline (p = 0.001). Additionally, Responders on the Mediterranean diet showed significant improvements in insulin sensitivity and β-cell function, marked by increases in the Insulin Sensitivity Index and Disposition Index (p = 0.011 and p = 0.018, respectively).
Conclusion: Neutrophils as Predictive Biomarkers for T2DM Remission
The study’s results suggest that neutrophil count may serve as a useful biomarker to identify patients who are more likely to achieve T2DM remission, especially in those following a Mediterranean diet. This connection highlights the potential role of neutrophils in insulin sensitivity and β-cell function. These findings pave the way for further research into the pathophysiology of T2DM and the potential of immune system modulation in disease remission.
Discussion
T2DM is not just a metabolic disorder but also one that impacts immune function. In hyperglycemic states, neutrophil activity can be compromised, leading to a reduced immune response. Neutrophil function plays a significant role in the inflammatory processes associated with insulin resistance and T2DM. Emerging research, including studies on neutrophil-related ratios, suggests these markers may predict not only T2DM risk but also remission, especially in response to lifestyle changes such as diet and physical activity.
By exploring new biomarkers like neutrophils, this study contributes to a deeper understanding of how immune system regulation might aid in managing or even reversing T2DM, offering hope for more effective, non-pharmacological interventions in the future.
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