Serum homocysteine level in type 2 diabetic patients with diabetic nephropathy and its relation to albumin excretion rate

Objective: Hypercysteinemia has been established as an independent risk factor for coronary atherosclerotic disease which is the most common cause of mortality in patients with type 2 diabetes mellitus [Type 2 DM]. This study was undertaken to investigate the relationship of homocysteine [tHcy] and renal function as presented by creatinine clearance [CICD and albumin excretion rate [AER] as marker of nephropathy in type 2 DM

Patients and Methods: A total of 50 patients with type 2 DM were screened; 15 patients had normo-albuminuria, 23 patients had micro-albuminuria and the remainder 12 patients had macro-albuminuria. These diabetic groups were subdivided based on CrCl to those with normal CrCl [CrCl > 80 mL/min] and those with low CrCl [CrCl < 80 mL/min]

Results: There were no significant differences in tHcy levels between microand nonno-albuminuric patients [15.7+/-4 vs 14.6+/-3.3, p>0.05], there were significantly higher levels of tHcy in macro-albuminuric patients in comparison to normo-albuminuric patients [25.6+/-7.5 vs 14.6+/-3.3, p<0.001]. In all groups of patients, tHcy levels were higher in those with low CrCl than those with normal CrCl [16.8+/-1 vs 13.8+/-3.5, p<0.01; 19.9+/-2.2 vs 13.5+/-2.8, p<0.001; 28.03+/-6.1 vs 13.6+/-3.0, p<0.001 in normo-albuminuric, micro-albuminuric and macro-albuminuric patient groups, respectively]. In all patients with normal CrCl, tHcy levels were comparable irrespective of AER [micro-albuminuria vs normoalbuminuria 13.5+/-2.8 vs 13.8+/-3.5, p>0.05; macro-albuminuria vs normo-albuminuria 13.6+/-3.0 vs l3.8+/-3.5, p>0.05]. However, in patients with low CrCl, tHcy levels were higher in those with micro-albuminuria than normo-albuminuric patients [19.9+/-2.2 vs 16.8+/-1.0, p=0.01] and in those with macro-albuminuria in comparison to nonno-albuminuric patients [28.03+/-6.1 vs 16.8+/-1.0, p<0.001]

Conclusion: Using multivariate regression, CrCl is the strongest predictor of tHcy levels in patients With type 2 diabetes. These data strongly suggest that in patients with type 2 DM, the relationship between plasma tHcy and AER is attributed to changes in renal function as defined by CrC

Urinary N-acetyl-beta-D-glucosaminidase in children with diabetes as an early marker of diabetic nephropathy

We investigated urinary N-acetyl-beta-D-glucosaminidase [NAG] levels in children with type 1 diabetes as an early marker of tubular damage and studied its correlation with microalbuminuria and glycaemic control. The study group comprised 42 children with type 1 diabetes and 20 healthy children as control. Urinary NAG to urinary creatinine ratio, microalbuminuria, glycated haemoglobin [Hb A1c], blood urea and serum creatinine were estimated. Urinary NAG levels in the children with diabetes were significantly higher than those of controls. There were positive correlations between urinary NAG levels and microalbuminuria, Hb A1c and systolic and diastolic blood pressure values. We found that 59.5% of diabetic children were positive for urinary NAG, while 38.1% of them were positive for microalbuminuria

Serum fructosamine as a monitor of periodontal therapy in diabetics

The effect of nonsurgical periodontal therapy on diabetics was investigated in the present study. Metabolic conditions was monitored by measuring serum fructosamine [SF]. Forty-eight adult NIDDM patients were selected, they were suffering from periodontal problems. After medical evaluation diabetic patients were divided into two groups: Moderate periodontitis group [periodontal disease index [PDI] between 3 and 4] and advanced periodontitis group PDI >4]. Gingival bleeding on probing [BoP], plaque index [PLI], serum fructosamine and blood glucose level were recorded to all diabetic patients before any periodontal therapy. The following periodontal treatment was then performed: Oral hygiene instruction, ultrasonic instrumentation, debridement of periodontal pockets and professional subgingival irrigation. All clinical and laboratory parameters were re- estimated after one-month period. The results showed a significant reduction in BoP and PLI in both groups after periodontal therapy, while significant decrease of PDI was recorded in patients with moderate periodontitis only FA showed a significant reduction in both groups after periodontal therapy. The results showed a positive relation between improvement of periodontal condition and reduction of serum fructosamine as severe periodontitis exaggerates FA values in diabetics. Therefore, periodontal status of diabetic patient must be considered when monitoring hyperglycemia