A study of correlation of HbA1c and homocysteine level in type II diabetic patients at tertiary health care centre

 

 

Abstract               Background: Diabetes mellitus (DM) is a group disorder characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. Aims and Objectives: To Study correlation of HbA1C and homocysteine level in type II diabetic patients at tertiary health care centre. Methodology: This was a cross-sectional study carried out in the Department of Medicine of a tertiary health care centre during the one year period i.e. January, 2017 to June, 2018 in the oneyear period there were 42 patients were enrolled to study, all the patients with the written consent were undergone with the routine testing were undergone HbA1 C level and homocysteine level in the biochemical laboratory. The statistical analysis was done by unpaired t-test and analyzed by SPSS 19 version of the software. Result: In our study we have seen that The majority of the patients were in the age group of 40-50 were 31.25%, followed by 27.08%, 30-40 were 18.75% , >60 were 16.67%,20-30 were 6.25%. The majority of the patients were Male i.e. 56.25%, and Female were 43.75% The level of Homocysteine was significantly higher as the Glycemic control become poor as t = 9.6487 df = 30 p<0.0001 (A vs C), t = 30.1886 df = 29, p<0.0001) (A vs D). Conclusion: It can be concluded from our study that level of Homocysteine was significantly higher as the Glycemic control become poor hence Homocysteine may be marker of complicated Diabetes and associated marker of cardiac diseases.

Key Word: Homocysteine, Glycemic control.

 

 

INTRODUCTION

Diabetes mellitus (DM) is a group disorder characterized by hyperglycemia resulting from defects in insulin secretion or insulin action¹. Chronic hyperglycemia in diabetes may cause permanent damage to the eyes, nerves and kidneys². Prevalence of diabetes is increasing due to population growth, aging, urbanization and increasing prevalence of obesity and physical inactivity³. Cardiovascular disease (CVD), being 2-4 folds more prevalent in type 2 diabetes mellitus, is still keeping its importance as the leading cause of death in this patient group⁴. Thus, the modulation of cardiovascular risk factors in these patients is very important. Homocysteine is an accepted risk factor for CVD. Hyper homocysteinemia is known to be associated with atherosclerosis, and this association is stronger in individuals with type 2 diabetes than in non-diabetic subjects⁵.

 

METHODOLOGY

This was a cross-sectional study carried out in the Department of Medicine of a tertiary health care centre during the one year period i.e. January, 2107 to June, 2018 in the one year period there were 42 patients were enrolled to study, all the patients with the written consent were undergone with the routine testing were undergone HbA1 C level and homocysteine level in the biochemical laboratory. All details of the patients were noted, the information like age, sex and Homocyestibn level with was noted. The statistical analysis was done by unpaired t-test and analyzed by SPSS 19 version of the software.

 

RESULT

Table 1: Distribution of the patients as per the age

The majority of the patients were in the age group of 40-50 were 31.25%, followed by 27.08%, 30-40 were 18.75%, >60 were 16.67%,20-30 were 6.25%.

 

 Table 2: Distribution of the patients as per the sex

The majority of the patients were Male i.e. 56.25%, and Female were 43.75%

 

Table 3: Distribution of the patients as per Glycemic control (HbA1C) and homocysteine level

The level of Homocysteine was significantly higher as the Glycemic control become poor as t = 9.6487 df = 30 p<0.0001 (A vs C), t = 30.1886 df = 29, p<0.0001) (A vs D).

DISCUSSION

Several studies have shown a positive correlation between glucose intolerance and cardiovascular disease with obesity, dyslipidaemia, hypertension, polycystic ovaries, smoking, sedentary lifestyle, certain ethnic groups, poorly regulated diabetes, and hyperinsulinaemia, due to any reason or risk factors. However, not all of these factors were able to explain the strong association of diabetes with premature atherosclerosis. Recently, it has been suggested that homocysteinaemia could be an important and independent predictor of complications in diabetes mellitus¹¹, especially atherothrombotic events. The European Union Concerted Action Project, “homocysteinaemia and vascular disease”, indicated that a plasma homocysteine level above 0.162 mg% accelerates the risk of myocardial infarction, cerebral or peripheral vascular disease in both men and women. There are studies suggesting that an elevated level of homocysteine in poorly controlled type-2 diabetes mellitus is related to increased risk of atherosclerosis and cardiovascular disease. The increased prevalence of elevated homocysteine levels in which macroangiopathy and nephropathy in type-2 diabetes mellitus was demonstrated¹² Homocysteine is a thiol containing amino acid that produced in methionine metabolism as intermediate⁶. This non-protein amino acid included in cardiovascular disease pathogenesis in several ways such as enhancement of blood coagulation⁶, oxidative stress⁷, endothelium dysfunction⁸ and cardiomyocyte dysfunction⁹. Studies have been shown that serum homocysteine levels are elevated in diabetic as well as non-diabetic patients with cardiovascular disease⁵. Current guidelines for treating patients with type 2 diabetes mellitus are based on glycemic control. Glycemic control is mandatory for prevention of diabetes complications¹⁰. In our study we have seen that The majority of the patients were in the age group of 40-50 were 31.25%, followed by 27.08%, 30-40 were 18.75%, >60 were 16.67%,20-30 were 6.25%. The majority of the patients were Male i.e. 56.25%, and Female were 43.75% The level of Homocysteine was significantly higher as the Glycemic control become poor as t = 9.6487 df = 30 p<0.0001 (A vs C), t = 30.1886 df = 29 , p<0.0001) (A vs D). These findings are similar to M. Akhvlediani et al ¹³ they found that homocysteine levels are significantly higher in complicated diabetes (22.0±0,7 mmol/l) than in patients without complications of diabeted (17.1±0.8 mmol/l). Significantly elevated homocysteine levels were found in patients with CAD, stroke and neuropathy as compared to control group. There was a positive correlation between homocysteine, total cholesterol, LDL and TG levels(r=3.44, r=3.67, and r=4.0). The correlation between microalbuminuria and homocystein were also positive (r= 3.92).

 

 

 

CONCLUSION

It can be concluded from our study that level of Homocysteine was significantly higher as the Glycemic control become poor hence Homocysteine may be marker of complicated Diabetes and associated marker of cardiac diseases.

 

REFERENCES

1. Del Prato S, Tiengo A. The importance of first phase insulin secretion: Implications for the therapy of type 2 diabetes mellitus. Diabetes Metab Res Rev 2001; 17(3): 164-74.
2. Ceriello A. Postprandial hyperglycemia and diabetes complications is it time to treat? Diabetes 2005; 54(1): 1- 7.
3. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diab Care 2004; 27(5): 1047-53.
4.  Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005; 365(9467): 1333-46.
5. Hoogeveen EK, Kostense PJ, Jakobs C, et al. Hyperhomocysteinemia increases risk of death, especially in type 2 diabetes: 5-year follow-up of the Hoorn Study. Circulation 2000; 101(13): 1506-11.
6.  Barchetta I, Riccieri V, Vasile M, et al. High prevalence of capillary abnormalities in patients with diabetes and association with retinopathy. Diab Med 2011; 28(9): 1039- 44.
7.  Zalba G, Fortuno A, San Jose G, et al. Oxidative stress, endothelial dysfunction and cerebrovascular disease. Cerebrovasc Dis 2007; 24(1): 24-9.
8. Yan SK, Chang T, Wang H, et al. Effects of hydrogen sulfide on homocysteine-induced oxidative stress in vascular smooth muscle cells. Biochem Biophys Res Commun 2006; 351(2): 485-91.
9. Tyagi N, Sedoris KC, Steed M, et al. Mechanisms of homocysteine-induced oxidative stress. Am J Physiol Heart Circ Physiol 2005; 289(6): H2649-H56.
10.  Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: A patient-centered approach position statement of the American diabetes association (ADA) and the european association for the study of diabetes (EASD). Diab Care 2012; 35(6): 1364- 79.
11.  Drzewoski J, Czupryniak L, Chwotko G, Bold F. Hyperhomocysteinemia in poorly controlled type 2 diabetes patients. Diabetes Nutr Metab 2000 Dec; 13(6): 319-24.
12. Boushey CJ, Beresford SAA, Omenn GS et al. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: probable benefits of increasing folic acid intakes. JAMA 1995; 274: 1049-1057.
13. M. Akhvlediani, M. Emukhvari , N. Zabakhidze . Diabetes Mellitus Complications Correlation Between Homocysteine And Type-2 Diabetes Mellitus Complication. Atherosclerosis 252 (2016) e1ee196