Volume : VI, Issue : IX, September - 2017

To study the association between plasma homocysteine and microvascular and macrovascular complications in type 1 Diabetes Mellitus.

Sudhir Bhandari, Prahlad Dhakar, Jaswant Goyal, Barkha Goyal, Purva Sharma

Abstract :

 Background

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long–term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels¹.

 

The worldwide prevalence of DM has risen dramatically over the past two decades, from an estimated 30 million cases in 1985 to 285 million in 2010. 366 million people have diabetes in 2011; by 2030 this will have risen to 552 million. 183 million people (50%) with diabetes are undiagnosed Diabetes caused 4.6 million deaths in 2011.78,000 children develop type 1 diabetes every year².

The chronic complications of DM affect many organ systems and are responsible for the majority of morbidity and mortality associated with the disease.

In a large cross sectional study of type 1 diabetic subjects, a significant and independent relationship was found between increased total homocysteine concentrations and macroalbuminuria, renal function and hypertension which suggests that total homocysteine might play an important role in the pathogenesis of vascular complications in type 1Diabetes³.

 

 

 

Materials & Methods

The study was conducted in out patient department of tertiary care hospital of north India . It was a hospital based Case–Control analytical type of observational study. This study was carried out From November 2011 to December 2012.

 

A total of 62 patients were enrolled in the study in which Cases include 31 patients of type1 diabetes mellitus with One or more vascular complications and controls include 31 patients of type1 diabetes Mellitus without any vascular complications.

 

They divide in 31Cases (25male and 6 female) and 31 controls (27 male and 4 female). Out of 31 cases 25 (80.65%) have retinopathy, 21(67.74%) have nephropathy and 14 (45.16%) have neuropathy and 3 patients have coronary artery disease and 1patient has peripheral artery disease. In 10 (32.26%) patients all 3 microvascular complications are present while in 9(29.03%) patients two microvascular complications are present.

 

Plasma total homocysteine was measured by Chemiluminescence Micropartide Immunoassay. Complications were diagnosed as Retinopathy by Fundus examination, neuropathy by nerve conduction study, coronary heart disease by ECG and nephropathy by microalbuminuria (Random spot urine sample for albumin–creatinine ratio).Between case and control group no significant difference in mean age, duration of diabetes, HbA1c, and vitamin B12 and folate level.

 

Results

The mean plasma homocysteine was higher in case group as compared to control group. (14.27 ± 4.99 vs.10.21 ± 3.0,P–value < 0.01).).Patients with non proliferative retinopathy have higher plasma homocysteine as compared to patients without retinopathy, but this is statistically non significant.(12.58±3.92 vs. 11.22±3.05, P–value > 0.05).Patients with proliferative retinopathy have statistically significant higher plasma homocysteine as compared to patients without retinopathy (18.64±4.41 vs. 11.22±3.05, P–value < 0.01).Patients with microalbuminuria have higher plasma homocysteine as compared to normoalbuminuric patients.(15.60 ± 4.61 vs. 11.50± 4.59, P–value < 0.05).Patients with neuropathy have higher plasma homocysteine as compared to patients without neuropathy. (15.77±5.09 vs.13.05±4.54, P–value > 0.05).

 

 

 

Discussion

 

Above finding suggests that homocysteine might play an important role in the pathogenesis of vascular complications in type 1 diabetes. The biological mechanism for the interaction between diabetes and elevated plasma homocysteine on vascular complications is still not well understood, although proposals include oxidative stress, endothelial damage and decreased nitric oxide bioavailability.

 

 

Conclusion

 

In Type 1 Diabetes Mellitus: Plasma homocysteine level is higher in patients with vascular complications as compared to patients without these complications. Proliferative retinopathy and microalbuminuria significantly associated with Plasma homocysteine level, but nonproliferative retinopathy and neuropathy does not show significant association.

 

Keywords :

Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Sudhir Bhandari, Prahlad Dhakar, Jaswant Goyal, Barkha Goyal, Purva Sharma, To study the association between plasma homocysteine and microvascular and macrovascular complications in type 1 Diabetes Mellitus., INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-6 | Issue-9 | September-2017

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