DOI: 10.5958/j.2319-5886.2.2.

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International Journal of Medical Research & Health Sciences

www.ijmrhs.com
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Volume 2 Issue 2 April - June

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Coden: IJMRHS

Copyright @2013

ISSN: 2319-5886
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Received: 12 Feb 2013 Research article

Revised: 8 Mar 2013

Accepted: 10 Mar 2013

SERUM HOMOCYSTEINE AND LIPID PROFILE LEVELS IN TYPE 2 DIABETES MELLITUS PATIENTS
* 1

Balu Mahendran K1, Santha K1, Santhoshkumar N2, GnanaDesigan E3,Mohammad Anwar4

Division of Biochemistry, 3Division of Physiology, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar,Tamil Nadu,India. 2 Department of Biochemistry, Shridevi Institute of Medical Sciences & Research Hospital,Tumkur, Karnataka, India 4 Department of Biochemistry, College of Medicine, Prince Salman Bin Abdul Aziz University, AlKharj, KSA.
ABSTRACT

Serum total homocysteine (tHcy) concentration is associated with increased risk factor for coronary heart diseases (CHD). The relation between type2 diabetes mellitus compared to the non diabetics is not clear. The current study represents an association between tHcy and cardiovascular disease is stronger in diabetics than in non-diabetic subjects. Materials & methods: Thirty type2 diabetic patients of both sexes with age group between 35-50 years selected as a study group. Thirty healthy, ages, both sexes subjects were selected as controls. Patients on insulin, Smokers, Alcoholics, Tobacco chewers, Hypertension, and other systemic illness were excluded from this study. Glucose, Lipid profile parameters analysed by fully automated analyzer. Total homocysteine is analyzed by enzyme immunoassay method. Results: The mean level of Glucose, serum Cholesterol, Triglycerides, LDL, and total Hcy levels are increased in type2 diabetic patients compared to the control group. The HDL level is significantly decreased in type2 diabetic patients compared to control group. Conclusion: The Serum total Hcy levels are associated with lipid profile in type2 diabetic patients. An elevated level of total Hcy leads coronary heart diseases. Keywords: Type2 diabetes mellitus, Homocysteine, Lipid profile, Coronary heart disease.
INTRODUCTION

Intracellular formation, metabolism, and release of Homocysteine into the extracellular compartment determine the concentration of homocysteine in extracellular media (e.g., plasma/serum), which in turn is the basis for measuring plasma/serum homocysteine as an extracellular marker for human diseases. Elevated levels of serum homocysteine have

been associated with state of coronary heart diseases. High levels of homocysteine in the serum, above15 mol/L, a medical condition called hyper homocysteinemia. In patients with type 2 diabetes mellitus, who is known to have a 2 to 4 fold increased risk for coronary heart disease (CHD) 1 . Homocystinuria refers to a group of rare inborn
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errors of metabolism resulting in high levels of circulating homocysteine 100 mol/L and 2 urinary homocysteine. Several epidemiological studies have been shown a relation between total homocysteine levels and coronary heart diseases 3-7 . In previous studies with diabetic patients, the association between elevated plasma homocysteine level and CHD events has been strong in case control and cross sectional studies 8 12 . The significance of hyper homocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function: decreased creatinine clearance, albuminuria, or both9,13-18. Type 2 diabetes is definitely associated with premature 19,20 atherosclerosis . Hyper homocysteinemia causes endothelial dysfunction by increasing oxidant stress21,22 and decreases the release of nitric oxide, impairing vasodilation2325. Excess of homocysteine stimulates smooth muscle cell proliferation and collagen synthesis promoting intima-media thickening2629. Hyperhomocysteinemia is also considered to have thrombogenic activity by increasing platelet aggregation and causing abnormalities in the coagulation system3033. High plasma homocysteine level is also shown to be associated with increased lipid peroxidation34. It is possible that statins have favorable effects on endothelial function in individuals with hyper homocysteinemia 35. Homocysteine as a marker of vitamin deficiency states 36.
MATERIALS AND METHODS

accordance with the Helsinki Declaration of 1975. Exclusion criteria Patients on insulin, Smokers, Alcoholics, Tobacco chewers, Hypertension, and other systemic illness were excluded from this study. Biochemical analysis: Fasting venous blood was collected in tubes containing EDTA. Blood samples were centrifuged at 2000g for 10 min. Samples were analysed for Fasting Blood Glucose, Lipid Profile (Total Cholesterol, HDL, LDL, Triglycerides), by using ERBA EM360 Fully automated analyzer . Measurement of tHcy: Measurement of tHcy in serum estimated by an enzyme conversion immunoassay (EIA). This assay is based on enzymatic conversion of tHcy (after reduction and release of endogenous homocysteine from proteins and/or disulfides) to S-adenosyl-L homocysteine (SAH) by the action of SAH hydrolase (EC 3.3.1.1), followed by quantification of SAH in a competitive immunoassay with the use of a monoclonal antibody against SAH 37. Statistical analysis: All results were shown as meanSD. The results were evaluated using Students t-test. P-value <0.05 was considered statistically significant. Statistical analysis was performed using SPSS software
RESULTS

In the present study, type 2 diabetic 30 patients, age group 35-50years, either sex, suffering less than 5 years duration of diabetics, who attending the out-patient department of Shridevi Institute of Medical Sciences & Research Hospital, Tumkur, Karnataka, were included after taking the inform consent from the patients and the study was approved by the institutional ethical committee overseeing human studies. Thirty healthy, age, and sex matched subjects were selected as controls. Experiments were done in

In normal individuals (control group) glucose mean level was 96.44 11mg/dl. In Type 2 diabetic patients the glucose was significantly raised being 244.4 41.08 mg/dl. Serum total Cholesterol was 175.92 22.84mg /dl. In Type 2 diabetic patients the mean levels of serum total cholesterol was significantly raised, the value being 201.2 29.69mg / dl. The Triglycerides in the control group are 105.2 27.82 mg/dl, while inType2 diabetic patients the mean triglycerides levels have significantly raised to 151.32 36.73 mg/dl. The mean HDL-Cholesterol in normal is 41.96 2.58mg/dl, while the mean value of HDL-Cholesterol in Type 2 diabetic patients is
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40.083.29mg/dl. HDL Cholesterol slightly decreased in Type 2 diabetic patients. The LDLCholesterol mean level in normal individuals was 109.16 25.54 mg/dl. In Type 2 diabetic patients the LDL- Cholesterol was significantly raised being 128.08 29.09 mg/dl. The homocysteine in the control group is 8.924 2.96 mol/l, while

in Type 2 diabetic patients the mean homocysteine levels have significantly raised to 15.064 4.82 mol/l. There is a significant difference of glucose, Cholesterol, triglycerides, HDL, LDL, homocysteine in control group & Type 2 diabetic group.

Table 1: Biochemical Data of control group and study group Control Group (n=30) Study Group (n=30) Parameter Mean SD Mean SD Homocysteine mol/L 8.924 2.96 15.064 4.82 Glucose (mg/dl) 96.44 11 244.4 41.08 Cholesterol (mg/dl) 175.92 22.84 201.2 29.69 Triglycerides (mg/dl) 105.2 27.82 151.32 36.73 Serum HDL (mg/dl) 41.96 2.58 40.08 3.29 Serum LDL (mg/dl) 109.16 25.54 128.08 29.09
DISCUSSION

P value <0.001 <0.000 < 0.001 < 0.001 < 0.045 < 0.001

We found a strong and independent association between elevated Serum homocysteine levels in Type 2 diabetic patients and risk for CHD events in our prospective study. Elevated levels of serum Homocysteine is a risk factor for overall mortality in type 2 diabetic patients. There are several prospective studies that have investigated the relation between tHcy and risk of cardiovascular disease. Many 38 40 but not all found a positive relation 41, 42. Several studies have explained the relation between B vitamins and serum tHcy levels. It has been suggested that hyperglycemia may cause an increased loss of water-soluble B vitamins 43. Lowering serum homocysteine reduces the risk of CHD in patients with type 2 diabetes mellitus. Patients with type 2diabetes with proteinuria more commonly have hyperhomocysteinemia than control subjects, and plasma tHcy levels in subjects with renal failure were markedly increased 44. In non-diabetic subjects, hyper homocysteinemia is often a feature of end-stage renal disease 45, 46.

CONCLUSION

In summary, our study shows that serum homocysteine levels are significantly raised; it is an independent risk factor for future CHD events in patients with type 2 diabetes with or without known CHD.
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