Homocysteine - As a Risk Factor and Predictor in the Development of Vascular Complications in Patients with Diabetes Mellitus Type 2

Abstract

BACKGROUND: Homocysteine (HCY) is a sulphur containing amino acid. The entire amount of homocysteine in the body is formed through the cycle of methylation of the amino acid methionine, as the primary and only source of homocysteine. The plasma free HCY is only 1%, while 70% is bound to albumin. The metabolism of HCY involves three enzymes: methionine synthase (MS) methylenetetrahydrofolate reductase (MTHFR), cystathionine B synthase (CBS) and the vitamins B6, B12 and folic acid as cofactors of these enzymes. In case of metabolic disturbance of the metabolism of HCY due to enzymatic defect or because of lack of intracellular cofactor, HCY accumulates in the cells, after which it is excreted from the cells and its plasma levels rise.

AIM: The purpose of this study is to obtain data that would prove the correlation of plasma homocysteine regarding the etiology of the microvascular and macrovascular complications of diabetes and the possibility of its use as an early predictor in the diagnosis of vascular complications in patients with diabetes mellitus.

METHODS: This paper is a retrospective-prospective study conducted at the Clinic for Endocrinology, Diabetes and Metabolic Diseases in Skopje. The study have included 80 patients with diabetes mellitus 2. Patients who are recruited were divided into two groups: 50 patients diagnosed with vascular complications and a group of 30 patients without associated complications, which will be the control group. The test group of patients will be made up of patients with type 2 diabetes mellitus, with confirmed diagnosis and treated with insulin and oral treatment.

RESULTS: From the preliminary results of the microvascular complications the most frequent and statistically significant is the prevalence of the nephropathy with 32%. Retinopathy was represented with 29 % and microalbuminuria was detected in 27.5% of the patients. Among the macrovascular complications 31 % of the patients were diagnosed with arterial hypertension and 12.50% with peripheral arterial diseases. In the present study higher levels of homocysteine were detected in group of diabetic subjects with microvascular and macrovascular complications comparing to control group of patients where no complications were diagnosed and levels of homocysteine were among reference ranges.

CONCLUSION: Hiperhomocisteinemia represents a risk factor in etiology of chronic complications in patients with diabetes mellitus type 2. However, further research would provide clear evidence of the impact of increased levels of homocysteine and its role in damage to the endothelium of blood vessels and the emergence of long-term vascular complications.