Homocysteine Levels and some Biochemical Parameters among Type 2 Diabetic Nephropathy Patients in Gaza City

Abstract

Background: Diabetes mellitus is prevalent in the Gaza strip. Recently, hyperhomocysteinemia was linked to diabetic nephropathy in type 2 diabetes. Objective: To assess homocysteine levels and some biochemical parameters among type 2 diabetic nephropathy patients inGazaCity. Materials and Methods: This cross sectional study comprised 120 diabetic patients distributed as follows: Group I: 40 normoalbuminuric patients (urinary albumin <30 mg/g), group II: 40 microalbuminuric patients (urinary albumin 30-300 mg/g) and group III: 40 macroalbuminuric patients (urinary albumin >300 mg/g). The control group included 40 non diabetic healthy individuals. A questionnaire interview was applied. Urinary albumin and protein were measured. Body mass index was determined. Serum homcysteine, glucose, urea, creatinine, cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), and whole blood HbA1c were determined. Results: The mean urinary albumin concentrations were 15.9±4.8, 22.3±5.2, 146.7±80.7 and 348±37.6 mg/g in control group, groups I, II and III, respectively. The mean ages were 56.9±6.2, 57.7±7.1, 57.8±5.4 and 58.5±6.3 years. Diabetic nephropathy was more prevalent among less educated and unemployment individuals as well as among individuals with family history of diabetes and those who frequently eat meat. The main self-reported complications among patients were retinopathy, cardiovascular diseases and neuropathy. The prevalence of such complications was significantly increased with the development of diabetic nephropathy. The ANOVA test showed a progressive significant increase in the mean levels of serum homocysteine recording the values of 13.4±3.7, 17.1±4.8, 20.3±5.9 and 22.9±5.5 µmol/l in controls, groups I, II and III, respectively (P=0.000). Body mass index was also significantly increase (P=0.000). Serum glucose and blood HbA1c in various diabetic groups exhibited significant gradual increase with the development of diabetic nephropathy (glucose: 225.6±51.1, 251.3±104.3 and 288.7±176.2 mg/dl and HbA1c: 7.6±1.1, 8.6±1.3, 8.8±1.4) in respect to control group (109.7±14.8 mg/dl and 4.7±0.6) with P=0.000. Similar trend was found for urea and creatinine showing values of 26.0±7.5, 48.7±5.38.1, 54.6±40.0 and 72.1±62.6 mg/dl in control group and groups I, II and III for urea, and 0.72±0.16, 0.89±0.62, 1.23±1.25 and 1.68±1.87 mg/dl for creatinine (P=0.000 and P=0.006, respectively). In general, there was gradual significant increase in cholesterol (P=0.001), triglycerides (P=0.000) and LDL-C (P=0.005) whereas HDL-C was significantly decreased (P=0.000) in different diabetic groups towards the development of diabetic nephropathy. Homocysteine levels were higher in less educated and unemployment individuals, individuals with family history of diabetes, and individuals who frequently eat meat and eat less fish. Homocysteine showed significant positive correlations with urinary albumin (r=0.564, P=0.000), serum glucose (r=0.465, P=0.000), blood HbA1c (r=0.517, P=0.000), serum urea (r=0.654, P=0.000), serum creatinine (r=0.561, P=0.000), triglycerides (r=0.320, P=0.001) and significant negative correlation with HDL-C (r=-0.517, P=0.000). Conclusion: Homocysteine level progressively increased with the development of diabetic nephropathy. Such levels correlated positively with urinary albumin, serum glucose, blood HbA1c, serum urea, creatinine and triglycerides, and negatively with HDL-C.