Relation of hyperhomocysteinemia to the severity of microvascular complications in type 2 diabetic patients

Abstract EN

Background: Homo cysteine is a non-essential amino acid; considered to be toxic when accumulated in the circulation and an important mediator in the pathogenesis of endothelial dysfunction in diabetes mellitus (DM).

There are lots of debates in the recent studies about the association of homo cysteine with diabetic micro vascular complications.

So, the aim of this work was to assess the possible relation of hyperhomocysteinemia to the severity of micro vascular complications in patients with type 2 DM.

Subjects and Methods: This study included 100 age and sex matched subjects, 80 cases with Type 2 DM and 20 healthy controls.

Subjects were divided into five groups.

Group I: Twenty healthy subject, Group II: Twenty patients with type 2 DM, without evidence of diabetic nephropathy, Group III: Twenty patients with type 2 DM with micro albuminuria, Group IV: Twenty patients with type 2 DM with overt nephropathy & Group V: Twenty patients with type 2 DM and renal impairment or failure.

All patients and controls were subjected to full medical history and clinical examination; including ophthalmological and neurological assessment, renal function tests, S.

albumin, 24hours urinary protein, creatinine clearance, quantitative measurement of micro albuminuria & plasma homo cysteine level.

Results: There was a significant positive correlation between plasma homo cysteine, s.

creatinine, age and duration of diabetes in all studied groups; while no significant statistical correlation between plasma homo cysteine and albumin excretion rate in all studied groups.

There was a significant negative correlation between plasma homo cysteine level and creatinine clearance.

Regarding plasma homo cysteine level there was insignificant difference when groups II and group III were compared with control subjects and highly significant difference when group IV and group V were compared with control subjects.

Conclusion: Rising levels of plasma homo cysteine in diabetic patients with nephropathy might be related to the severity of diabetic nephropathy and this was mainly due to associated decline of glomerular filtration rate reflected by creatinine clearance and not due to associated changes of albumin excretion rate in different stages of diabetic nephropathy.

Also, we observed that hyperhomocysteinemia is positively correlated with the severity of diabetic retinopathy, and neuropathy.

We recommend further studies about the role of homo cysteine lowering drugs for treatment of micro vascular diabetic complications.