Serum Homocysteine Values are Associated with Diabetic Foot Ulcer

ABSTRACT

Background: Diabetic foot ulcers and lower extremity amputations are leading causes of mortality and morbidity in diabetic patients. Diabetic neuropathy and peripheral vascular diseases are major reasons for the development of diabetic foot ulcer. Most of the studies showed that hyperhomocysteinemia is related with microvascular and macrovascular complications in diabetic patients. In addition, hyperhomocysteinemia is related to poor ulcer healing. In this study, we investigated the relationship of hyperhomocysteinemia with diabetic foot ulcers.
Materials and Methods: Fifty-one patients with diabetic foot ulcers, 35 diabetes patients without foot ulcers and 60 healthy individuals were enrolled in the study. Wagner classification of diabetic foot ulcers was used. Plasma homocysteine levels were measured by Florescence Polarization Immunoassay.
Results: The median age was 60.0±10.5 years (Range: 38-85 years) in diabetic foot ulcer group, 57.8±9.6 years (range: 41-74 years) in diabetic group and 55.6±6.8 years (range: 40-70 years) in control group (p=0.062). The groups were similar in terms of mean age and sex distribution. The mean homocysteine levels were 10.7 μmol/l (range: 7-22 μmol/l) in control group, 16.27 μmol/l (range: 8.1-31.8 μmol/l) in diabetic foot ulcer group, 13.38 μmol/l (range: 7/23.6 μmol/l) in diabetic group and were showing statistically significant difference between the groups (p<0.001). However, no difference was seen between diabetic foot ulcer group and diabetic group (p>0.05). Multiple logistic regression analysis showed that, peripheral neuropathy and hyperhomocysteinemia (OR 10.558, p=0.008 and OR 1.186, p=0.013, respectively) were independent risk factors for the development of diabetic foot ulcer.
Conclusion: Serum homocysteine values are associated with diabetic foot ulcer.