Changes in CBC-derived inflammatory indices following dapagliflozin initiation in patients with type 2 diabetes mellitus
7 affiliations
- 1Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University
- 2Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University
- 3Health Holding Company, Riyadh Second Health Cluster
- 4Department of Medicine, Division of Nephrology, College of Medicine, King Saud University
- 5Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU)
- 6Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs
- 7King Abdullah International Medical Research Center
Abstract
Background: Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade inflammation, which contributes to metabolic dysfunction and vascular complications. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are used for glycemic control and provide cardiovascular and renal benefits that may involve inflammatory pathways, in part. However, short-term changes in complete blood count (CBC)-derived inflammatory indices after initiating SGLT2 inhibitors remain poorly characterized. This study aimed to assess changes in CBC-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), following dapagliflozin initiation in patients with type 2 diabetes mellitus (T2DM). A secondary exploratory objective was to identify demographic and clinical factors potentially associated with statistically significant pre–post changes in the indices.
Methods: This retrospective study used electronic health record data from adults with T2DM who initiated dapagliflozin in 2023 or 2024. A total of 441 patients met the eligibility criteria for paired baseline and six-month hematological assessments. We assessed changes in neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Correlation and multivariable regression analyses examined associations with selected clinical characteristics.
Results: Significant reductions in NLR (p = 0.039), MLR (p = 0.015), SII (p = 0.034), and SIRI (p = 0.016) were observed six months after dapagliflozin initiation, whereas PLR did not change significantly (p = 0.055). However, the corresponding effect sizes were small (r = 0.098–0.116). All four reductions remained statistically significant following Benjamini–Hochberg false discovery rate adjustment. Exploratory multivariable analyses identified associations between selected clinical comorbidities and changes in inflammatory indices; however, these associations were sensitive to influential observations and were not reproduced in median regression analyses.
Conclusions: Several CBC-derived inflammatory indices decreased during the six-month period following dapagliflozin initiation in patients with T2DM, suggesting measurable changes in systemic inflammatory status over time. These routinely available indices may provide useful adjunctive information when evaluating inflammatory profiles in patients with T2DM. Further prospective studies with comparator groups and established inflammatory biomarkers are warranted to confirm these findings and clarify their clinical significance.
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BibTeX
@article{alsudais2026changes,
title = {{Changes in CBC-derived inflammatory indices following dapagliflozin initiation in patients with type 2 diabetes mellitus}},
author = {Hamood AlSudais and Abdulrahman Alshalani and Turky AlSulaiman and Fawziah AlShehri and Bandar Alqarni and Abdulaziz M. Almuqrin and Rehab B. Albakr and Jehad A. Aldali and Badi A. Alotaibi},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.2012568},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.2012568/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Changes in CBC-derived inflammatory indices following dapagliflozin initiation in patients with type 2 diabetes mellitus
AU - Hamood AlSudais
AU - Abdulrahman Alshalani
AU - Turky AlSulaiman
AU - Fawziah AlShehri
AU - Bandar Alqarni
AU - Abdulaziz M. Almuqrin
AU - Rehab B. Albakr
AU - Jehad A. Aldali
AU - Badi A. Alotaibi
PY - 2026
DA - 2026/11/04
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.2012568
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.2012568/full
AB - Background: Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade inflammation, which contributes to metabolic dysfunction and vascular complications. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are used for glycemic control and provide cardiovascular and renal benefits that may involve inflammatory pathways, in part. However, short-term changes in complete blood count (CBC)-derived inflammatory indices after initiating SGLT2 inhibitors remain poorly characterized. This study aimed to assess changes in CBC-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), following dapagliflozin initiation in patients with type 2 diabetes mellitus (T2DM). A secondary exploratory objective was to identify demographic and clinical factors potentially associated with statistically significant pre–post changes in the indices. Methods: This retrospective study used electronic health record data from adults with T2DM who initiated dapagliflozin in 2023 or 2024. A total of 441 patients met the eligibility criteria for paired baseline and six-month hematological assessments. We assessed changes in neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Correlation and multivariable regression analyses examined associations with selected clinical characteristics. Results: Significant reductions in NLR (p = 0.039), MLR (p = 0.015), SII (p = 0.034), and SIRI (p = 0.016) were observed six months after dapagliflozin initiation, whereas PLR did not change significantly (p = 0.055). However, the corresponding effect sizes were small (r = 0.098–0.116). All four reductions remained statistically significant following Benjamini–Hochberg false discovery rate adjustment. Exploratory multivariable analyses identified associations between selected clinical comorbidities and changes in inflammatory indices; however, these associations were sensitive to influential observations and were not reproduced in median regression analyses. Conclusions: Several CBC-derived inflammatory indices decreased during the six-month period following dapagliflozin initiation in patients with T2DM, suggesting measurable changes in systemic inflammatory status over time. These routinely available indices may provide useful adjunctive information when evaluating inflammatory profiles in patients with T2DM. Further prospective studies with comparator groups and established inflammatory biomarkers are warranted to confirm these findings and clarify their clinical significance.
SN - 1664-2392
ER -