From the Guidelines
Diabetes mellitus (DM) can indeed result in chronic leukocytosis, as evidenced by the presence of systemic symptoms such as marked leukocytosis in patients with diabetic foot infections 1. This occurs because diabetes, especially when poorly controlled, creates a state of chronic low-grade inflammation in the body. The elevated blood glucose levels damage blood vessels and tissues, triggering an immune response that increases white blood cell production. Some key points to consider include:
- Diabetic patients are more susceptible to infections, which can further contribute to leukocytosis
- The inflammatory cytokines released in diabetes, such as interleukin-6 and tumor necrosis factor-alpha, stimulate bone marrow to produce more white blood cells
- This leukocytosis is typically mild to moderate in severity, with white blood cell counts usually ranging from 11,000 to 15,000 cells per microliter
- Proper management of diabetes through medication adherence, blood glucose control, regular exercise, and dietary modifications can help reduce the inflammatory state and normalize white blood cell counts over time It's essential for healthcare providers to consider diabetes as a potential cause when evaluating chronic leukocytosis, especially in patients with other signs of metabolic syndrome, as highlighted in the 2016 American Diabetes Association standards of medical care in diabetes 2 and the 2018 classification and diagnosis of diabetes standards 3.
From the Research
Diabetes Mellitus and Leukocytosis
- Diabetes mellitus (DM) can lead to chronic inflammation, which may result in leukocytosis, as seen in patients with poorly controlled diabetes 4.
- A study found that significant glycemic reduction in patients with poorly controlled diabetes led to reduced circulating white blood cell (WBC) counts and inflammatory gene expression 4.
- However, another study suggested that leukocytosis in diabetic ketoacidosis (DKA) is not a reliable indicator of concomitant bacterial infection, and C-reactive protein (CRP) levels may be a more reliable indicator 5.
Causes of Leukocytosis
- Leukocytosis can have various causes, including infection, malignancy, and nonmalignant conditions such as stress, exercise, and certain medications 6.
- A study found that extreme leukocytosis was attributed to infection in 48 cases, advanced malignancy in 13 cases, and other causes in 22 cases 7.
- Chronic inflammatory conditions, such as those seen in diabetes, can also lead to leukocytosis 4.
Evaluation of Leukocytosis
- Evaluation of patients with leukocytosis should include a repeat complete blood count with peripheral smear, and consideration of age- and pregnancy-specific normal ranges for the white blood cell count 6.
- The leukocyte differential may show eosinophilia in parasitic or allergic conditions, or lymphocytosis in childhood viral illnesses 6.
- Symptoms suggestive of a hematologic malignancy, such as fever, weight loss, bruising, or fatigue, should prompt referral to a hematologist/oncologist 6.