The Changes Of Plasma Total Homocysteine In Type 2 Diabetic Patients And The Relationship Between Plasma Total Homocysteine And Diabetic Vascular Complications

[OBJECTIVE]â‘ To study plasma total homocysteine (tHcy) level in normal glucose tolerance(NGT)and type 2 diabetes mellitus(T₂DM) subjects and search for contributing factor to tHcy .â‘¡To investigate the possible relationship between tHcy and diabetic vascular complications.[RESEARCH DESIGN AND METHODS]â‘ One hundred and thirty-five subjects( fifty-five cases in NGT group , eighty cases in T₂DM group) were enrolled in this cross section study. The height, weight, waist circumference, hip circumference, blood pressure were measured in all subjects, and calculated body mass index(BMI) and waist-hip ratio(WHR). Fasting plasma total homocysteine, fasting serum vitamin B₁₂, fasting plasma folic acid were assessed. Oral glucose tolerance and insulin releasing test were performed to assess insulin secretion(area under the curve (AUC) and insulin sensitivity(HOMA-IR) was calculated). Lipid protein including total cholesterol(TC), triglycerides(TG), high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) , hemoglobin Alc (HbAlc), and uric acid(UA) were assessed at the same time.â‘¡Multiple stepwise regression analysis was used to study contributing factor of tHcy.â‘¢Logistic regression analysis was used to investigate the relationship between tHcy and diabetic vascular complications.[RESULTS]â‘ Plasma tHcy in T₂DM subjects (21.09±10.99μmol/L) was significantly high(P=0.000) than that in NGT (3.70±5.54μmol/L) .â‘¡Multiple stepwise regression analysis showed Ln AUCGlu and WC were important contributors to tHcy (Adj-R²=0.378, P =0.000).â‘¢The result of Logistic regression analysis was that tHcy(OR=1.109)and age(OR=1.146) were independent risk factors to diabetic macroangiopathy.[CONCLUSIONS]â‘ The concentration of plasma tHcy increased in patients with type 2 diabetes and gender was not contributed to the concentration of tHcyâ‘¡Glucose and WC were important contributors to tHcy in NGT and T₂DM patient .â‘¢The value of tHcy was important contributor to diabetic macroangiopathy. [OBJECTIVE] To assess the changes of plasma total homocysteine (tHcy) concentration in T₂DM with insulin intensive therapy.[RESEARCH DESIGN AND METHODS] A total of Sixty-eight type 2 diabetic patients were enrolled in the randomized control study. All subjects received insulin intensive therapy. They were randomly divided in two groups.â‘ Insulin intensive therapy group(group A) was treated with insulin only for six month.â‘¡Patient in union therapy group(group B) was treated with insulin, vitaminB₁₂ and folic acid for six month. Before treatment, the height, weight, waist circumference, hip circumference, blood pressure were measured in all subjects, and calculated body mass index(BMI) and waist-hip ratio(WHR). The fasting plasma total homocysteine, fasting serum vitamin B₁₂, fasting plasma folic acid were assessed. Lipid protein including total cholesterol(TC), triglycerides(TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c) , hemoglobin Alc (HbAlc), and uric acid(UA) were assessed at the same time. All variables were measured in all subjects after six months.[RESULTS]â‘ Plasma tHcy level were no significant different between group A and group B before therapy(26. 31±11. 76/μmol/L and 19. 06 + 7. 27/μmol/L respectively, P>0.05).â‘¡There was no significant difference of tHcy level before(26.31 + 11.76μmol/L) and after treatment(24. 52 + 11. 47μmol/L) in group A (P>0.05). The tHcy level decreased markedly after taking vitaminB₁₂ and folic acid in group B(19. 06 + 7. 27μmol/L(before treatment) and 13. 95 + 5. 57μmol/L(after treatment), P =0.031).â‘¢Plasam tHcy level in group B were significant lower than those in group A after treatment(13. 95±5. 57μmol/L(group B) and 24.52±11. 47μmol/L(groupA), P =0.004).[CONCLUSIONS]â‘ There was no significant effect statistically on plasma tHcy level in T₂DM with insulin intensive therapy only.â‘¡Based on insulin intensive therapy, the concentration of tHcy in T₂DM could be reduced significantly by taking vitamin B₁₂ and folic acid replacement therapy.