Klinik Araştırma
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Tip 1 Diyabet Mellitus'ta Mikrovasküler Komplikasyonların Tahmininde HALP Skorunun Etkinliği.

Yıl 2025, Cilt: 58 Sayı: 3, 120 - 125, 24.02.2026
https://izlik.org/JA55GN77XY

Öz

Amaç. Tip 1 diabetes mellitus'un (T1DM) mikrovasküler komplikasyonları önemli bir morbidite ve mortalite nedenidir. Artan kanıtlar, inflamasyon ve beslenmenin diyabetik mikrovasküler komplikasyonların gelişiminde önemli bir rol oynadığını göstermektedir. Bu çalışmanın amacı, T1DM'li hastalarda immünnütrisyonel durumun değerli bir göstergesi olan Hemoglobin, Albümin, Lenfosit ve Trombosit (HALP) skoru ile üç diyabetik mikrovasküler komplikasyon arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem. Çalışmaya toplam 193 T1DM hastası dahil edildi ve retrospektif olarak değerlendirildi. Sosyodemografik ve klinik veriler anamnez ve tıbbi kayıtlardan elde edildi. Biyokimyasal parametreler standart laboratuvar yöntemleriyle ölçüldü. Mikrovasküler komplikasyonlar güncel kılavuzlara göre değerlendirildi. Tüm hastaların HALP skorları hesaplandı.
Bulgular. Mikrovasküler komplikasyonları olan ve olmayan hastalar arasında yaş, cinsiyet ve vücut kitle indeksi açısından anlamlı bir fark saptanmadı. Diyabetik böbrek hastalığı (DKD) grubunun ortalama HALP skoru, DKD olmayan gruba kıyasla anlamlı derecede düşüktü (40,66 ± 9,31 vs. 52,30 ± 15,14, p <0,001). Diyabetik retinopati (DR) grubunun ortalama HALP skoru, DR olmayan gruba kıyasla anlamlı derecede düşüktü (38,58 ± 9,35 vs. 52,07 ± 14,75, p <0,001). Diyabetik nöropati (DN) grubunda ortalama HALP skoru, DN olmayan gruba kıyasla daha düşüktü (43,33 ± 12,53 vs. 52,47 ± 14,97, p <0,001). Her üç mikrovasküler komplikasyonun varlığı HALP skoru ile negatif korelasyon gösterdi.
Sonuç. Bulgularımız, T1DM'li hastalarda daha düşük HALP skoru değerlerinin diyabetik mikrovasküler komplikasyonların varlığıyla ilişkili olabileceğini düşündürmektedir. Bilgilerimize göre bu, T1DM'li hastalarda üç kronik mikrovasküler komplikasyon ile HALP skoru arasındaki ilişkiyi araştıran ilk çalışmadır.
Anahtar Kelimeler: Diyabetik böbrek hastalığı, diyabetik nöropati, diyabetik retinopati, HALP skoru, Type 1 diabetes mellitus.

Etik Beyan

Bu çalışma Helsinki Bildirgesi’ne uygun olarak yürütülmüş ve Etlik Şehir Hastanesi Kurumsal Etik Kurulu tarafından onaylanmıştır. (Onay no: 2025/368; Tarih: 05.08.2025).

Destekleyen Kurum

Yoktur.

Teşekkür

Bu araştırma kamu, ticari veya kâr amacı gütmeyen sektördeki herhangi bir fon kuruluşundan özel bir hibe almamıştır.

Kaynakça

  • 1. McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early KB, Bruemmer D, et al.2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S27-s49.
  • 2. Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380(9854):1662- 1673.
  • 3. McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early KB, Bruemmer D, et al.12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S252-s265.
  • 4. McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early KB, Bruemmer D, et al.11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S239-s251.
  • 5. Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL, et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care. 2017;40(9):1226-1232.
  • 6. Rübsam A, Parikh S, Fort PE. Role of Inflammation in Diabetic Retinopathy. Int J Mol Sci. 2018;19(4).
  • 7. Wang Y, Liu Y, Gu W, Cai B, Lei M, Luo Y, et al. Association of immune-inflammation indexes with incidence and prognosis of diabetic nephropathy: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2025;16:1532682.
  • 8. Doupis J, Lyons TE, Wu S, Gnardellis C, Dinh T, Veves A. Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy. J Clin Endocrinol Metab. 2009;94(6):2157-2163.
  • 9. Cho A, Hong YS, Park HC, Kim DH, Shin YJ, Lee YK. Geriatric nutritional risk index is associated with retinopathy in patients with type 2 diabetes. Sci Rep. 2022;12(1):11746.
  • 10. Fujiwara M, Kimura H, Tanaka K, Saito H, Shimabukuro M, Asahi K, et al. Association between malnutrition and adverse renal outcomes in patients with type 2 diabetes. J Diabetes Investig. 2025;16(1):100-107.
  • 11. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP's prognostic ability in different cancer types. Oncotarget. 2023;14:153-172.
  • 12. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-41382.
  • 13. Zhang T, Liu P. Association of hemoglobin, albumin, lym - phocyte, and platelet score with all-cause and cardiovascular mor - tality in adults with diabetes or prediabetes: Results from NHANES 2005-2018. Prev Med Rep. 2025;54:103101.
  • 14. Zhu X, Zhang Y, Wang A, Zhang X, Yu G, Xiang S, et al. Association between HALP (hemoglobin, albumin, lymphocyte, and platelet) score and poor outcomes in acute ischemic stroke patients with type 2 diabetes mellitus: a study from the Third China National Stroke Registry. Front Neurol. 2024;15:1461188.
  • 15. Wang S, Jia B, Niu S, Chen S. Relationship Between the Hemoglobin, Albumin, Lymphocyte Count, Platelet Count (HALP) Score and Type 2 Diabetes Retinopathy. Diabetes Metab Syndr Obes. 2024;17:2693-2706.
  • 16. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of ar - terial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the mana - gement of arterial hypertension of the European Society of Car - diology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041.
  • 17. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136- 154.
  • 18. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lan - cet. 2010;376(9735):124-136.
  • 19. Zhu Y, Cai Q, Li P, Zhou Y, Xu M, Song Y. The relations - hip between peripheral blood inflammatory markers and diabetic macular edema in patients with severe diabetic retinopathy. Ann Palliat Med. 2022;11(3):984-992.
  • 20. Suslova TE, Sitozhevskii AV, Ogurkova ON, Kravchen - ko ES, Kologrivova IV, Anfinogenova Y, et al. Platelet hemostasis in patients with metabolic syndrome and type 2 diabetes mellitus: cGMP- and NO-dependent mechanisms in the insulin-mediated platelet aggregation. Front Physiol. 2014;5:501.
  • 21. Carollo C, Sorce A, Cirafici E, Ciuppa ME, Mulè G, Caimi G. Silent Inflammation, Loud Consequences: Decoding NLR Ac - ross Renal, Cardiovascular and Metabolic Disorders. Int J Mol Sci. 2025;26(17).
  • 22. Moon JY, Jeong KH, Lee TW, Ihm CG, Lim SJ, Lee SH. Aberrant recruitment and activation of T cells in diabetic nephro - pathy. Am J Nephrol. 2012;35(2):164-174.
  • 23. Niewczas MA, Pavkov ME, Skupien J, Smiles A, Md Dom ZI, Wilson JM, et al. A signature of circulating inflammatory proteins and development of end-stage renal disease in diabetes. Nat Med. 2019;25(5):805-813.
  • 24. Rayego-Mateos S, Morgado-Pascual JL, Opazo-Ríos L, Guerrero-Hue M, García-Caballero C, Vázquez-Carballo C, et al. Pathogenic Pathways and Therapeutic Approaches Targeting Inf - lammation in Diabetic Nephropathy. Int J Mol Sci. 2020;21(11).
  • 25. Anders HJ, Huber TB, Isermann B, Schiffer M. CKD in dia - betes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol. 2018;14(6):361-377.
  • 26. Tauchi E, Hanai K, Babazono T. Effects of dietary protein intake on renal outcome and mortality in patients with advanced diabetic nephropathy. Clin Exp Nephrol. 2020;24(2):119-125.
  • 27. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabe - tic retinopathy. Diabetes Care. 2012;35(3):556-564.
  • 28. Sharma Y, Saxena S, Mishra A, Saxena A, Natu SM. Nut - rition for diabetic retinopathy: plummeting the inevitable threat of diabetic vision loss. Eur J Nutr. 2017;56(6):2013-2027.
  • 29. Wu Y, Dong D, Liu Y, Xie X. Prognostic nutritional index and diabetic peripheral neuropathy in type 2 diabetes: a machine learning approach. Nutr Metab (Lond). 2025;22(1):26

The Utility of the HALP Score in Predicting Microvascular Complications in Type 1 Diabetes Mellitus.

Yıl 2025, Cilt: 58 Sayı: 3, 120 - 125, 24.02.2026
https://izlik.org/JA55GN77XY

Öz

Aim. Microvascular complications of type 1 diabetes mellitus (T1DM) are a significant cause of morbidity and mortality. Increasing evidence suggests that inflammation and nutrition play an important role in the development of diabetic microvascular complications. The aim of the present study was to investigate the association between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, a valuable indicator of immunonutritional status, and three diabetic microvascular complications in patients with T1DM.
Material and Method. A total of 193 patients with T1DM were included and retrospectively evaluated. Sociodemographic and clinical data were obtained from medical records. Biochemical parameters were measured with standard laboratory methods. Microvascular complications were evaluated according to current guidelines. The HALP scores of all patients were calculated.
Results. No significant differences were found between patients with and without microvascular complications in terms of age, gender, and BMI. The mean HALP score of the diabetic kidney disease (DKD) group was significantly lower compared to the non-DKD group (40.66±9.31 vs. 52.30±15.14, p<0.001). The mean HALP score of the diabetic retinopathy (DR) group was significantly lower compared to the non-DR group (38.58±9.35 vs. 52.07±14.75, p<0.001). The mean HALP score was lower in the diabetic neuropathy (DN) group than in the non-DN group (43.33±12.53 vs. 52.47±14.97, p<0.001). The presence of all three microvascular complications was negatively correlated with the HALP score.
Conclusions. Our findings suggest that a reduced HALP score may be associated with the presence of diabetic microvascular complications in patients with T1DM. To our knowledge, this is the first study to investigate the relationship between three chronic microvascular complications and HALP scores in patients with T1DM.
Keywords: Diabetic kidney disease, diabetic neuropathy, diabetic retinopathy, HALP score, Type 1 diabetes mellitus.

Etik Beyan

This study was conducted in accordance with the Declaration of Helsinki and was approved by the institutional ethics committee of Etlik City Hospital (Approval no: 2025/368; Date: 05.08.2025).

Destekleyen Kurum

None.

Teşekkür

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Kaynakça

  • 1. McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early KB, Bruemmer D, et al.2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S27-s49.
  • 2. Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380(9854):1662- 1673.
  • 3. McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early KB, Bruemmer D, et al.12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S252-s265.
  • 4. McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Early KB, Bruemmer D, et al.11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S239-s251.
  • 5. Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL, et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care. 2017;40(9):1226-1232.
  • 6. Rübsam A, Parikh S, Fort PE. Role of Inflammation in Diabetic Retinopathy. Int J Mol Sci. 2018;19(4).
  • 7. Wang Y, Liu Y, Gu W, Cai B, Lei M, Luo Y, et al. Association of immune-inflammation indexes with incidence and prognosis of diabetic nephropathy: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2025;16:1532682.
  • 8. Doupis J, Lyons TE, Wu S, Gnardellis C, Dinh T, Veves A. Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy. J Clin Endocrinol Metab. 2009;94(6):2157-2163.
  • 9. Cho A, Hong YS, Park HC, Kim DH, Shin YJ, Lee YK. Geriatric nutritional risk index is associated with retinopathy in patients with type 2 diabetes. Sci Rep. 2022;12(1):11746.
  • 10. Fujiwara M, Kimura H, Tanaka K, Saito H, Shimabukuro M, Asahi K, et al. Association between malnutrition and adverse renal outcomes in patients with type 2 diabetes. J Diabetes Investig. 2025;16(1):100-107.
  • 11. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP's prognostic ability in different cancer types. Oncotarget. 2023;14:153-172.
  • 12. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-41382.
  • 13. Zhang T, Liu P. Association of hemoglobin, albumin, lym - phocyte, and platelet score with all-cause and cardiovascular mor - tality in adults with diabetes or prediabetes: Results from NHANES 2005-2018. Prev Med Rep. 2025;54:103101.
  • 14. Zhu X, Zhang Y, Wang A, Zhang X, Yu G, Xiang S, et al. Association between HALP (hemoglobin, albumin, lymphocyte, and platelet) score and poor outcomes in acute ischemic stroke patients with type 2 diabetes mellitus: a study from the Third China National Stroke Registry. Front Neurol. 2024;15:1461188.
  • 15. Wang S, Jia B, Niu S, Chen S. Relationship Between the Hemoglobin, Albumin, Lymphocyte Count, Platelet Count (HALP) Score and Type 2 Diabetes Retinopathy. Diabetes Metab Syndr Obes. 2024;17:2693-2706.
  • 16. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of ar - terial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the mana - gement of arterial hypertension of the European Society of Car - diology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041.
  • 17. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136- 154.
  • 18. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lan - cet. 2010;376(9735):124-136.
  • 19. Zhu Y, Cai Q, Li P, Zhou Y, Xu M, Song Y. The relations - hip between peripheral blood inflammatory markers and diabetic macular edema in patients with severe diabetic retinopathy. Ann Palliat Med. 2022;11(3):984-992.
  • 20. Suslova TE, Sitozhevskii AV, Ogurkova ON, Kravchen - ko ES, Kologrivova IV, Anfinogenova Y, et al. Platelet hemostasis in patients with metabolic syndrome and type 2 diabetes mellitus: cGMP- and NO-dependent mechanisms in the insulin-mediated platelet aggregation. Front Physiol. 2014;5:501.
  • 21. Carollo C, Sorce A, Cirafici E, Ciuppa ME, Mulè G, Caimi G. Silent Inflammation, Loud Consequences: Decoding NLR Ac - ross Renal, Cardiovascular and Metabolic Disorders. Int J Mol Sci. 2025;26(17).
  • 22. Moon JY, Jeong KH, Lee TW, Ihm CG, Lim SJ, Lee SH. Aberrant recruitment and activation of T cells in diabetic nephro - pathy. Am J Nephrol. 2012;35(2):164-174.
  • 23. Niewczas MA, Pavkov ME, Skupien J, Smiles A, Md Dom ZI, Wilson JM, et al. A signature of circulating inflammatory proteins and development of end-stage renal disease in diabetes. Nat Med. 2019;25(5):805-813.
  • 24. Rayego-Mateos S, Morgado-Pascual JL, Opazo-Ríos L, Guerrero-Hue M, García-Caballero C, Vázquez-Carballo C, et al. Pathogenic Pathways and Therapeutic Approaches Targeting Inf - lammation in Diabetic Nephropathy. Int J Mol Sci. 2020;21(11).
  • 25. Anders HJ, Huber TB, Isermann B, Schiffer M. CKD in dia - betes: diabetic kidney disease versus nondiabetic kidney disease. Nat Rev Nephrol. 2018;14(6):361-377.
  • 26. Tauchi E, Hanai K, Babazono T. Effects of dietary protein intake on renal outcome and mortality in patients with advanced diabetic nephropathy. Clin Exp Nephrol. 2020;24(2):119-125.
  • 27. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabe - tic retinopathy. Diabetes Care. 2012;35(3):556-564.
  • 28. Sharma Y, Saxena S, Mishra A, Saxena A, Natu SM. Nut - rition for diabetic retinopathy: plummeting the inevitable threat of diabetic vision loss. Eur J Nutr. 2017;56(6):2013-2027.
  • 29. Wu Y, Dong D, Liu Y, Xie X. Prognostic nutritional index and diabetic peripheral neuropathy in type 2 diabetes: a machine learning approach. Nutr Metab (Lond). 2025;22(1):26
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Endokrinoloji
Bölüm Klinik Araştırma
Yazarlar

Burcu Candemir 0000-0003-1800-6235

Burak Menekşe 0000-0002-1010-110X

Burçak Cavnar Helvacı 0000-0002-8356-4463

Erman Çakal 0000-0003-4455-7276

Gönderilme Tarihi 9 Ekim 2025
Kabul Tarihi 4 Kasım 2025
Yayımlanma Tarihi 24 Şubat 2026
DOI https://doi.org/10.20492/aeahtd.1800053
IZ https://izlik.org/JA55GN77XY
Yayımlandığı Sayı Yıl 2025 Cilt: 58 Sayı: 3

Kaynak Göster

AMA 1.Candemir B, Menekşe B, Cavnar Helvacı B, Çakal E. The Utility of the HALP Score in Predicting Microvascular Complications in Type 1 Diabetes Mellitus. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2026;58(3):120-125. doi:10.20492/aeahtd.1800053