Homocysteine and Some Biochemical Parameters in Type 2 Diabetic Patients from Gaza Governorate

Abstract

Background: Diabetes mellitus is prevalent in The Gaza Strip. Recently, hyperhomocysteinemia has been linked to the pathophysiology of type 2 diabetic patients. Objective: To assess homocysteine and some biochemical parameters in type 2 diabetic patients from Gaza Governorate, Gaza Strip. Materials and Methods: This case control study comprised 84 diabetic patients taken from Al Rimal diabetic clinic and Al-Shifa hospital in Gaza Governorate. And 84 healthy controls were included. Cases and controls were matched with age and gender. A questionnaire interview was applied. Serum homocysteine, glucose, urea, creatinine, cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and whole blood HbA1c were determined. Data were analyzed using SPSS version 18.0. Results: The mean ages of controls and cases were 49.2±7.6and 50.1±5.8 years. Diabetes mellitus was more prevalent among unemployment individuals as well as among individuals with family history of diabetes. Two thirds of patients were not on diet. In addition, the prevalence of diabetes was higher among individuals who frequently eat meat. The self-reported complications among diabetic patients were retinopathy, cardiovascular disease, neuropathy, nephropathy, recurrent infections, skin lesions and oral cavity lesions. The prevalence of retinopathy and neuropathy showed positive significant association with the duration of diabetes. The t-test showed significant increase in BMI of diabetic patients compared to controls (30.1±5.6 vs. 25.7±3.7, p= 0.000). The mean level of serum homocysteine was significantly higher in diabetic patients compared to controls (20.8±5.4 vs.13.4±3.7 µmol/l, P=0.000). Higher levels of homocysteine were found in unemployed cases and those with family history of diabetes as well as individuals who ate meat daily. The mean levels HbA1c and glucose were significantly higher in patients than in controls (7.5±1.4% and 252.9±119.5 mg/dl Vs. 4.7±0.6% and 108.7±13.7 mg/dl, P=0.000). The average levels of cholesterol, triglycerides and LDL-C were higher in cases (240.3±84.7, 215±89.7 and 154.1±84.4 mg/dl, respectively) compared to controls (180.2±28.6, 123.3±60.1 and 107.0±23.9 mg/dl, respectively) with P=0.000, P=0.000 and P=0.001, respectively. On the other hand, HDL-C was significantly lower in cases (41.3±11.3 Vs. 46.9±7.1 mg/dl, P=0.015). Urea and creatinine concentrations were significantly elevated in cases compared to controls (59.4±52.3 and 1.4±1.6 mg/dl Vs. 26.0±7.5 and 0.72±0.16 mg/dl, p=0.000 and p=0.005, respectively). The Pearson correlation test showed positive significant correlations of homocysteine with BMI, HbA1c, glucose, triglyceride, urea and creatinine ( r=0.214, P=0.045; r= 0.473, P=0.000; r=0.508, P=0.000; r=0.422, P=0.000; r=0.647, P=0.000 and r=0.601, P=0.000, respectively). On the other hand, there was a negative significant correlation between homocysteine and HDL-C level (r=-0.443, P=0.000). Conclusions: The significant increase of homocysteine in diabetic patients and its positive significant correlations with BMI, HbA1c, glucose, triglyceride, urea and creatinine and negative significant correlation with HDL-C makes it a possible biomarker for diabetes and may indicate its pathophysiological role in the disease.