ABSTRACT
BACKGROUND: Elevated plasma homocysteine is a recently-recognized independent risk factor for cardiovascular disease. In patients with non-insulin dependent diabetes mellitus (NIDDM), plasma homocysteine concentration was reported to be elevated in association with nephropathy. However, inconsistent results were reported about the association with other microvascular complications. METHODS: To determine the relationship between plasma homocysteine and the development of chronic diabetic microvascular complications, fasting plasma homocysteine, glycemic control, lipid and lipoprotein levels, vitamin status, renal function test, and chronic diabetic microvascular complications were assessed in 101 patients with NIDDM in the present study. RESULTS: There was no difference in the plasma levels of homocysteine by sex, age, status of sugar control, duration of diabetes, other cardiovascular risk factors. Patients with diabetic microangiopathy had higher plasma homocysteine concentrations than those without diabetic microangiopathy. Moreover, there was a significant correlation between amount of urinary albumin excretion and plasma homocysteine level (p=0.004, r=0.357). However, multivariate analysis showed that only serum creatinine (beta=0.635) was independently associated with plasma homocysteine level in NIDDM patients. The increase in plasma homocysteine was not shown to increase the risk of diabetic microvascular complications independently on multiple logistic regression analysis. CONCLUSION: In conclusion, decrease of renal function is an independent determinant of plasma homocysteine level and higher plasma homocysteine is associated to diabetic microangiopathy. But an increase in plasma homocysteine in patients with NIDDM is not independently associated with diabetic microvascular complications considering renal function. Therefore, the renal function should be considered in study about relationship between plasma homocysteine level and the development and/or progression of chronic diabetic microvascular complications in diabetic patients.