Homocysteine and B12 in type 2 diabetic patients and its relation to the different therapeutic modalities

Abstract EN

Background : Diabetes mellitus has been defined as a coronary heart disease risk equivalent.

Hyperhomocysteinemia has received increasing attention during the past decade as a significant independent risk factor for cardiovascular disease.

In type 2 diabetes, plasma homocysteine levels are influenced by the duration of disease, metabolic control and type of therapy.

Aim of the study: To study the incidence of hyperhomocysteinemia among type 2 diabetic patients receiving different anti-diabetic therapies and its relation to the different therapeutic modalities. Subjects and methods: This study was conducted on 60 type 2 diabetic patients &10 healthy volunteers as a control group.

The diabetic subjects were divided into 3 groups 20 patients each according to type of therapy: group I: on metformin therapy, group II: on sulfonylurea therapy and group III: on insulin therapy.

For all the subjects, full history taking, thorough clinical examination, fasting and postprandial plasma glucose, HbA1c, renal profile, lipid profile, vitamin B12 level and fasting plasma homocysteine were assayed. Results: * High values of homocysteine were found in type 2 diabetic patients compared to control group p<0.01.

There was a significant positive correlation between plasma homocysteine and duration of type 2 DM among all groups. * Metformin group had the highest level of homocysteine and lowest level of vitamin B12 compared to other groups and was statistically highly significant.

There was a significant positive correlation between plasma homocysteine and duration of metformin treatment. * Plasma homocysteine was higher in males than females and vitamin B12 level was higher in females than males among all studied groups, which was statistically significant.

There was a highly significant inverse correlation between plasma homocysteine level and vitamin B12 level among all studied groups. * There was a decrease in vitamin B12 level in the type 2 diabetic patients compared to control group, which is statistically highly significant. * There was an inverse correlation between vitamin B12 levels versus age among all studied groups but statistically insignificant. Conclusion: We concluded from our results that hyperhomocysteinemia is prevalent among patients with type 2 diabetes.

The levels are affected by the different modalities of therapy.

Noticeably, metformin therapy is associated with hyperhomocysteinemia and low B12 levels.

The level of increase is directly correlated to the duration of therapy and the degree of metabolic control.