Estimation of Serum Homocysteine Level in Patients with Type 2 Diabetic Neuropathy

Abstract

Background: Hyperhomocysteinemia and non-insulin-dependent diabetes mellitus (NIDDM) are both associated with premature vascular disease. Data indicate that homocysteine is independently associated with the prevalence of peripheral sensorimotor and autonomic neuropathy in type 2 diabetic patients. Objective: To investigate the association between homocysteine level and the prevalence of neuropathy in type 2 diabetes mellitus. Methods: Twenty six type 2 diabetic patients and 16 healthy control subjects were enrolled. Neuropathy was diagnosed according to clinical symptoms, clinical examination and electrophysiological sensory and motor testing. Homocysteine-related parameters (plasma homocysteine, folate and vitamin B12) were determined. Results: Diabetic patients had a significantly higher plasma levels of homocysteine compared to controls, (p=0.001). Significantly lower serum levels of vitamin B12 and folic acid were detected in diabetic patients compared to controls, (p=0.000; 0.011 respectively). Females had significantly lower mean levels of folic acid and Vitamin B12 than males (p= 0.045, 0.037 respectively). A significant positive correlation was found between duration of diabetes; PPBS; HbA1c and homocysteine levels, (P= 0.019, 0.005, 0.000 respectively). A significant positive correlation was found between homocysteine level with PPBS and HbA1c, (P=0.019, 0.001 respectively). Levels of folic acid and Vit B12 were positively correlated (p= 0.000). No correlation was also found between the type of neuropathy and homocysteine, Vitamin B12 and folic acid levels. Conclusion: Elevated serum homocysteine is associated with the presence of diabetic neuropathy in type 2 diabetic patients. Future studies are needed to establish hyperhomocysteinaemia as a clinically significant modifiable risk factor in the pathogenesis of diabetic neuropathy.