Association between homocysteine and Glycated Hemoglobin in pre-diabetic and diabetic patients of Karachi Pakistan
DOI:
https://doi.org/10.59736/IJP.23.01.939Keywords:
Diabetes Mellitus, Glycated Hemoglobin A1c, Glycemic Control, Homocysteine, Prediabetic StateAbstract
Background: Diabetes Mellitus (DM) is a metabolic disorder related to high morbidity and mortality. This study aims to investigate the relationship between plasma homocysteine (Hcy) levels and Glycated Hemoglobin A1c (HbA1c) levels in individuals with pre-diabetes and diabetes mellitus.
Methods: This study was conducted at the Department of Chemical Pathology, Dow University of Health Sciences (DUHS), Karachi, involving 148 participants (74 pre-diabetic, 74 diabetic). Plasma Hcy levels and HbA1c levels were measured using the Siemens Atellica Analyzer. Statistical analysis was performed using SPSS version 26. Mann-Whitney U test, Spearman’s correlation, and linear regression were used to analyze data, considering level of significance (p<0.005).
Results: Diabetic participants had significantly higher Hcy levels (31.94 ± 8.88 µmol/L) compared to pre-diabetic individuals (26.55 ± 12.57 µmol/L) (p < 0.001). HbA1c levels were also significantly higher in diabetics (7.97 ± 0.98%) compared to pre-diabetics (6.05 ± 0.18%) (p < 0.001). Weak but significant positive correlation was observed between Hcy and HbA1c (r = 0.225, p = 0.006). Linear regression analysis showed that Hcy levels explained 4.9% of the variance in HbA1c levels (R = 0.222, p = 0.007).
Conclusion: We observed a weak but statistically significant association between hcy and HbA1c levels. It highlights the need for further research to explore potential mechanisms and confounding factors.
References
Nadhiya J, Vijayalakshmi M, Showbharnikhaa S. A Brief Review on Diabetes Mellitus. Journal of Pharma Insights and Research. 2024;2(1):117-21.
Ofori EK, Amponsah SK, Pathak YV. Overview: Biochemical Basis of Metabolic Diseases. Current Trends in the Diagnosis and Management of Metabolic Disorders. 2023:1-16.
Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. Journal of the Endocrine Society. 2024;8(1):bvad167.
Alam S, Aijaz M. COMPLICATIONS OF CARDIOVASCULAR DISEASE: THE IMPACT OF DIABETES, DYSLIPIDEMIA, AND METABOLIC DISORDERS. 2024.
Rehman T, Shabbir MA, Inam‐Ur‐Raheem M, Manzoor MF, Ahmad N, Liu ZW, et al. Cysteine and homocysteine as biomarker of various diseases. Food science & nutrition. 2020;8(9):4696-707.
Esse R, Barroso M, Tavares de Almeida I, Castro R. The contribution of homocysteine metabolism disruption to endothelial dysfunction: state-of-the-art. International journal of molecular sciences. 2019;20(4):867.
Leri M. Molecular insights into amyloid aggregation and cytotoxicity. 2015.
Yazdanpanah S, Rabiee M, Tahriri M, Abdolrahim M, Rajab A, Jazayeri HE, et al. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review. Critical reviews in clinical laboratory sciences. 2017;54(4):219-32.
Elhefnawy ME, Ghadzi SMS, Noor Harun S. Predictors associated with type 2 diabetes mellitus complications over time: a literature review. Journal of Vascular Diseases. 2022;1(1):13-23.
Kunutsor SK, Balasubramanian VG, Zaccardi F, Gillies CL, Aroda VR, Seidu S, et al. Glycaemic control and macrovascular and microvascular outcomes: A systematic review and meta‐analysis of trials investigating intensive glucose‐lowering strategies in people with type 2 diabetes. Diabetes, Obesity and Metabolism. 2024;26(6):2069-81.
Chatterjee U. Exploring the Interplay Between Glycosylated Hemoglobin and Dyslipidemia in Individuals with Type 2 Diabetes Mellitus.
Biswas S. A review on the pharmacological effects of hormonal and antidiabetic drugs in the treatment of Polycystic Ovary Syndrome: Brac University; 2019.
Adib F. Effect of Combination Metformin and Gliclazide on Creatinine level in Patients Suffering from Type 2 Diabetes: East West University; 2016.
Elmaci I, Altinoz MA. A metabolic inhibitory cocktail for grave cancers: metformin, pioglitazone and lithium combination in treatment of pancreatic cancer and glioblastoma multiforme. Biochemical genetics. 2016;54(5):573-618.
Khan A, Rehman S, Ghaffar T. Association of homocysteine with body mass index, blood pressure, HbA1c and duration of diabetes in type 2 diabetics. Pakistan Journal of Medical Sciences. 2018;34(6):1483.
Bidwe SE, Hisalkar PJ, Mallick N. Homocysteine (Hyc) in prediabetes: An early indicator of Cardiovascular disease. 2019.
Chethan Y. A Study of Plasma Homocysteine Levels in Type 2 Diabetes Mellitus and its Correlation with Diabetic Retinopathy: Rajiv Gandhi University of Health Sciences (India); 2019.
Ebesunun MO, Obajobi EO. Elevated plasma homocysteine in type 2 diabetes mellitus: a risk factor for cardiovascular diseases. Pan African medical journal. 2012;12(1).
Herrmann W, Herrmann MJN. The controversial role of HCY and vitamin B deficiency in cardiovascular diseases. 2022;14(7):1412.
Bansal S, Kapoor S, Singh G, Yadav SJIJoCMR. Serum homocysteine levels in type 2 diabetes mellitus patients. 2016;3(11):3393-6.
Abdulhameed LQ, Sultan AA, AL-Mahdawi ZMM, editors. Homocysteine: A recent potential risk factor for type 2 diabetes mellitus patients in Diyala Province. AIP Conference Proceedings; 2023: AIP Publishing.
Chen X, Zhang X, Nie Y, Gong Z, Sivaprasad S, Fung AT, et al. Circulating level of homocysteine contributes to diabetic retinopathy associated with dysregulated lipid profile and impaired kidney function in patients with type 2 diabetes mellitus. 2023;37(7):1383-9.
Shen Z, Zhang Z, Zhao WJBn. Relationship between plasma homocysteine and chronic kidney disease in US patients with type 2 diabetes mellitus: a cross-sectional study. 2022;23(1):419.
Aghamohammadi V, Pourghassem Gargari B, Aliasgharzadeh AJJoAiM, Research B. Evaluation of the level of plasma homocysteine in patients with type 2 diabetes mellitus under metformin treatment and its correlation with serum total antioxidant capacity, malondialdehyde, creatinine, insulin resistance and glycemic control. 2011;19(76):1-10.
Khan A, Rehman S, Ghaffar TJPJoMS. Association of homocysteine with body mass index, blood pressure, HbA1c and duration of diabetes in type 2 diabetics. 2018;34(6):1483.
Chen S-F, Cui C-L, Wu P, Xie N-ZJIJoC, Medicine E. Relationship of serum homocysteine level with nutritional status and HbA1c level in elderly inpatients. 2013;6(9):779.
Alatawi AM, Albogami AF, Aldharman SS, Majrashi SM, Alghamdi RS, Boobaid NE, et al. Therapeutic and Adverse Effects of Metformin in Diabetes: A Review Article.(2023).13(1):L261-72.
Infante M, Leoni M, Caprio M, Fabbri AJWjod. Long-term metformin therapy and vitamin B12 deficiency: an association to bear in mind. 2021;12(7):916.
Kim J, Ahn CW, Fang S, Lee HS, Park JSJM. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. 2019;98(46):e17918.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Ghulam Murtaza Jamali, Sahar Iqbal, Syed Talha Naeem, Humaira Ahmed, Fouzia Zeeshan Khan

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.