Serum Electrolyte Dysregulation and Inflammatory Burden in Type 2 Diabetes: Development of a Novel Electrolyte-Inflammation Risk Score for Predicting Glycemic Control and Cardiovascular Complications

Objective

This study aimed to develop and validate a novel Electrolyte-Inflammation Risk Score (EIRS) integrating serum electrolytes and high-sensitivity C-reactive protein (hs-CRP), to predict glycemic control and cardiovascular risk in patients with type 2 diabetes mellitus (T2DM).

Methods

A cross-sectional case-control study was conducted at Sri Lalithambigai Medical College, Chennai, involving 100 participants (50 patients with T2DM and 50 age-matched healthy controls). Fasting blood glucose, HbA1c (measured by HPLC using the Bio-Rad D-10 system), serum sodium, potassium, and chloride (measured using an ion-selective electrode on the Roche Cobas), magnesium (measured by the xylidyl blue colorimetric method), and hs-CRP (measured by a particle-enhanced immunoturbidimetric assay) were measured. Statistical analysis included independent t-tests, Pearson correlation, multivariate logistic regression, and ROC curve analysis (SPSS version 28.0; p < 0.05).

Results

T2DM patients exhibited significant electrolyte imbalances compared with controls: elevated potassium (5.40 ± 0.65 vs. 4.16 ± 0.82 mmol/L), increased sodium (142.6 ± 3.5 vs. 138.2 ± 2.3 mmol/L), reduced magnesium (1.8 ± 0.4 vs. 2.1 ± 0.3 mg/dL), and markedly elevated hs-CRP (4.8 ± 2.1 vs. 1.1 ± 0.7 mg/L; all p < 0.001 or p < 0.05). Multivariate logistic regression identified elevated sodium (OR = 2.84, 95% CI: 1.23–6.57, p = 0.015), elevated potassium (OR = 3.42, 95% CI: 1.45–8.08, p = 0.005), elevated hs-CRP (OR = 4.73, 95% CI: 2.15–10.41, p < 0.001), and higher BMI (OR = 1.12 per kg/m², 95% CI: 1.01–1.24, p = 0.031) as independent predictors of HbA1c > 8%. The EIRS, which is based on the four laboratory parameters, achieved an AUC of 0.847 (95% CI: 0.765–0.929, p < 0.001) at an optimal cut-off of ≥ 4 points, with 84% sensitivity and 78% specificity. High-risk patients (score 6–8) had 100% poor glycemic control and a 78% incidence of cardiovascular events, compared with 67% and 33% in moderate-risk and 13% and 8% in low-risk patients, respectively.

Conclusion

The EIRS effectively identifies patients with T2DM at high risk of poor glycemic control and cardiovascular complications, offering a practical tool for the simultaneous assessment of metabolic and inflammatory risk.