Plasma homocysteine levels are associated with ulceration of the foot in patients with type 2 diabetes mellitus.
BACKGROUND
To examine the association of biochemical markers of risk (plasma Hcy, microalbuminuria, lipoprotein (a)(Lp(a)) and diabetic dyslipidaemia) with the prevalence of diabetic foot ulceration in type 2 diabetic patients.


METHODS
Case/control study conducted in 198 type 2 diabetic patients. 89 patients have foot ulcers and 109 have no foot ulcers (control group), in order to establish ORs for diabetic foot ulceration. In all subjects plasma Hcy, Lp(a), total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, HbA(1c) and microalbuminuria were measured using standard procedures.


RESULTS
Plasma Hcy, microalbuminuria, HbA(1c) and apolipoprotein B levels were significantly higher in patients with foot ulceration compared with the control group. Plasma lipids, Lp(a), vitamin B12 and folic acid values were similar in both groups. In the logistic regression model, plasma Hcy (OR 1.09; 95% CI 1.04-1.69), microalbuminuria (OR 1,01; 95% CI 1.01-1.17) and HbA(1c) levels (OR 1.33; 95% CI 1.04-1.69) were independent risk factors for the presence of diabetic foot ulceration.


CONCLUSIONS
In our study, for each micromol increase in plasma Hcy levels there was a 10% increase in the risk of diabetic foot ulceration. In addition, plasma homocysteine, HbA(1c) and microalbuminuria accounted for 50% prevalence risk of diabetic foot ulceration. Further prospective studies should be conducted to confirm the association of plasma Hcy levels with the risk of foot ulceration.
Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain.
R
R
González
T
T
Pedro
Jose T
JT
Real
S
S
Martínez-Hervás
M R
MR
Abellán
R
R
Lorente
A
A
Priego
M
M
Catalá
F J
FJ
Chaves
J F
JF
Ascaso
R
R
Carmena
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications; D001055:Apolipoproteins B / Q000097:blood; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D017719:Diabetic Foot / Q000097:blood* / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D012306:Risk
D001055:Apolipoproteins B; D006442:Glycated Hemoglobin; D006710:Homocysteine