Total homocysteine levels' relation with chronic complications of diabetes, body composition, and other cardiovascular risk factors in a population of patients with diabetes mellitus type 2

Abstract

The significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function and vitamin status. The aim of our study was to analyze the relationship between total homocysteine (tHcy) in a population of type 2 diabetic patients and chronic complications. We also analyzed the relationship between tHcy and the body composition of these patients and other cardiovascular risk factors. In a cross-sectional study, a total of 155 patients with diabetes mellitus attending in our diabetes service (90 females/65 males) were enrolled in a consecutive way. All enrolled patients underwent the following examinations: (i) biochemical cardiovascular risk factors including total cholesterol, triglyceride, lipoprotein (a), low-density lipoprotein (LDL-cholesterol), high-density lipoprotein (HDL-cholesterol), glucose, HbA 1c , fibrinogen, homocysteine, vitamin B12, folate, and microalbuminuria; and (ii) fat mass assessed by body mass index, weight, percentage of fat mass, and tricipital skinfold. Patients were divided in two groups (Group I: tHcy≥15 μmol/l; Group II: tHcy<15 μmol/l). Smoking habit was similar in both groups. A prevalence of cerebrovascular accident was present in 3.3% in the total group. This prevalence was not different in both groups (7.4% vs. 2.3%; ns) (OR 3.3; 95% CI 0.49–19.68). The prevalence of coronary heart disease in the total group was 5.8% without statistical differences between groups (3.5% vs. 6.3%; ns) (OR 0.57; 95% CI 0.065–4.53). Concerning macrovascular complications, only peripheral vascular disease prevalence was higher in Group I (16% vs. 3.1%; P <0.05; OR 5.33; 95% CI 1.18–21.5). A prevalence of nephropathy was higher in Group I (93.3% vs. 12.8%; P <0.05; OR 7.15; 95% CI 2.9–17.9). No statistical differences were detected in prevalence of retinopathy (global group 41.9%) (42.5% vs. 40.9%; ns) (OR 1.75; 95% CI 0.78–3.9). Also, peripheral neuropathy was similar in both groups (7.1% vs. 6.5%; ns) (OR 1.1; 95% CI 0.15–8.2). No correlation was detected among homocysteine and anthropometric parameters (body mass index, weight, percentage of fat mass, fat mass, and tricipital skinfold). Elevated levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure were detected in Group I. The present study shows that elevation of plasma tHcy levels in type 2 diabetic patients is associated with a higher prevalence of peripheral arteriopathy and nephropathy. Our data suggest that hyperhomocysteinemia is not associated with fat mass but it is associated with high levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure levels.