The HOMA IR strongly correlated with the clamp IR in type 2 diabetic patients treated with SUs as well as in those treated with diet alone.

The results indicated that diabetic patients showed more advanced changes in atherosis than that in sclerosis as compared with age- and sex-matched control subjects. Such atherotic changes in diabetic patients may be associated with hyperlipidemia.

Arterial stiffness indexes beta of CCA and FA were associated with insulin resistance in NIDDM subjects.

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OBJECTIVE -To assess the impacts of insulin resistance and renal function on plasma total homocysteine (tHcy) levels in patients with type 2 diabetes with a wide range of nephropathy.RESEARCH DESIGN AND METHODS -Plasma tHcy levels were measured using the enzyme immunoassay method in 75 patients with type 2 diabetes and compared with those in 54 healthy control subjects. Insulin sensitivity indexes were assessed in patients with type 2 diabetes by hyperinsulinemic-euglycemic clamp using artificial pancreas.RESULTS -Plasma tHcy levels and their log-transformed values (log tHcy) were significantly higher in all patients with diabetes than in control subjects (tHcy, 12.0 Ϯ 0.7 [SE] vs. 8.7 Ϯ 0.3 mol/l, P Ͻ 0.0001; log tHcy, 1.040 Ϯ 0.021 vs. 0.920 Ϯ 0.016 mol/l, P Ͻ 0.0001). Plasma tHcy levels in patients with diabetes were significantly increased according to degree of nephropathy (P Ͻ 0.0001). On simple regression analyses, log tHcy correlated with insulin sensitivity indexes (r ϭ -0.319, P ϭ 0.005) as well as creatinine clearance (r ϭ 0.634, P Ͻ 0.0001) in all patients with diabetes. Multiple regression analyses showed that insulin sensitivity indexes (␤ ϭ -0.245) as well as creatinine clearance were independent contributors to log tHcy in all patients with diabetes (R 2 ϭ 0.750, P Ͻ 0.0001). For the 59 patients with diabetes with creatinine clearance Ͼ60 ml/min, insulin sensitivity indexes were also shown to be a significant contributor to log tHcy (␤ ϭ -0.438, R 2 ϭ 0.561, P Ͻ 0.001).CONCLUSION -Insulin resistance and renal function are independent determinants of tHcy levels in patients with type 2 diabetes. Diabetes Care 24:533-538, 2001H omocysteine is a sulfur-containing amino acid formed during the conversion of methionine to cysteine. Since the first report by Wilcken et al. (1), increased plasma total homocysteine (tHcy) level has been recognized as an independent risk factor for coronary atherosclerotic disease (2,3), which is the most common cause of mortality in patients with type 2 diabetes. There is controversy concerning plasma tHcy levels in type 2 diabetes. Plasma tHcy levels in patients with type 2 diabetes are reported to be similar to or higher than those in healthy subjects (4 -6). Plasma tHcy levels are reported to be associated with hypertension, hyperuricemia, impaired renal function, and increased risk for development of coronary atherosclerotic disease (7-10). Insulin resistance has been hypothesized to play an important role in the development of atherosclerotic disease (11). Therefore, the association of insulin resistance with plasma tHcy levels must be clarified as it relates to development of atherosclerotic disease. Only a few studies have investigated the association between insulin resistance and plasma tHcy levels in healthy subjects (12)(13)(14)(15), and a few studies in animals have suggested that insulin affects the activities of key enzymes in homocysteine metabolism (16,17). It has not been clarified whether insulin resistance in type 2 diabetes is associated with plasma tH...