Homocysteine is Linked to Macular Edema in Type 2 Diabetes

Li, Jianbo; Zhang, Hongman; Shi, Min; Lü, Yan; Xie, Min

doi:10.3109/02713683.2013.877933

Cited by 12 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, the coefficient of variation (CV) for intrasubject day-to-day reproducibilities of NSE analysis for our normal control and diabetic participants were 7.2% and 9.8%, respectively. Furthermore, like our previous report [23], we did not find that thiazolidenediones were closely linked to the occurrence of retinopathy or macular oedema.…”

Section: Discussionsupporting

confidence: 76%

Serum neuron‐specific enolase is elevated as a novel indicator of diabetic retinopathy including macular oedema

Zhang

et al. 2014

Diabet. Med.

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 76%

Serum neuron‐specific enolase is elevated as a novel indicator of diabetic retinopathy including macular oedema

Zhang

et al. 2014

Diabet. Med.

View full text Add to dashboard Cite

show abstract

“…; Li et al. ). While the pathogenesis of this association is not clear it is known that hyperhomocysteinemia leads to vascular injury by a combination of oxidative stress, decreased nitric oxide availability, endothelial cell apoptosis and enhanced thrombogenecity; therefore, high levels of homocysteine could theoretically promote inner BRB disruption(Lai & Kan ).…”

Section: Discussionmentioning

confidence: 97%

Serum pro‐inflammatory factors as predictors of persistent diabetic macular oedema with limited anatomic response to anti‐VEGF: association with intravitreal injection treatment profiles in real‐world setting

Brito

Costa

Gomes

et al. 2019

Acta Ophthalmologica

View full text Add to dashboard Cite

Purpose: To study the role of serum levels of pro-inflammatory factors in the identification of persistent diabetic macular oedema (DME) cases with limited anatomic response to anti-VEGF. Additionally, possible predictive associations between serum factors and intravitreal treatment profiles were analysed. Methods: Cases with DME were treated with monthly bevacizumab (BVZ). After the sixth month of follow-up, if the change in central foveal thickness (CFT) was <20% of baseline, combination treatment with triamcinolone was initiated. All cases underwent a baseline laboratory workup including inflammatory, metabolic and prothrombotic factors. The following outcome parameters were evaluated: percentage of CFT change from baseline, occurrence of persistent DME with <20% change in CFT, achieving CFT <330 lm with ≤6 BVZ injections, total number of intravitreal injections (IVI), number of IVI after the 6th month and number of triamcinolone acetonide (TCA) injections. Results: A total of 58 cases were included receiving a mean of 7.23 AE 1.55 IVI in 12 months, resulting in a significant improvement of visual acuity (VA) and CFT. No significant differences were found for baseline CFT, baseline LogMAR VA, diabetic retinopathy grade, age or duration of DM2 between cases initiating TCA and those treated only with anti-VEGF. Significant correlations were found between total number of IVI and the following serum factors: high-sensitivity C-reactive protein (hsCRP) (p = 0.004, r = 0.395), creatinine (p = 0.023, r = 0.338) and homocysteine (p = 0.037, r = 0.309). Regression analysis revealed that hsCRP was a significant predictor of TCA treatment (p = 0.028, r 2 = 0.350). Cases requiring ≤6 IVI had significantly lower values of hsCRP (1.33 AE 1.07 versus 2.46 AE 2.18 mg/l, p = 0.016) and creatinine (0.71 AE 0.28 versus 0.94 AE 0.19 mg/dl, p = 0.003). Conclusions: Serum markers of microvascular damage (hsCRP, homocysteine and creatinine) were associated with a higher frequency of IVI due to persistent DME, suggesting a role for such biomarkers in the identification of limited responders to anti-VEGF monotherapy.

show abstract

“…The association between Hcy concentration and DME was independent of other risk factors, OR = 1.63, CI 1.02-2.14, p = 0.018. Each increase of 5.0 μmol/L in plasma Hcy concentration was associated with a 64% higher risk of DME (OR = 1.64, CI 1.04-2.16, p = 0.019) after controlling for other factors [7].…”

Section: Serum/plasma B12mentioning

confidence: 96%

“…Similarly, patients with type 1 diabetes with HHcy had an elevated risk (OR = 1.83, 95% CI 1.28-2.62) [6]. Homocysteine (Hcy) concentration was found to be statistically significantly associated with macular edema among Chinese type 2 diabetes patents [7]. Patients with Diabetic Macular Edema (DME) had a higher Hcy concentration, mean Hcy = 11.4 μmol/L, compared to macular edema -free controls, mean concentration = 8.5 μmol/l, p = 0.000.…”

Section: Serum/plasma B12mentioning

confidence: 97%

Vitamin B12 for Diabetes Patients Treated with Metformin

Pawlak¹

2017

J Fam Med Dis Prev

View full text Add to dashboard Cite

Metformin treatment, both duration and dose, is associated with increased risk of vitamin B12 (B12) deficiency. B12 deficiency causes Hyperhomocysteinemia (HHcy), which is associated with an increased risk of a variety of diabetic co-morbidities. As a result, the newest "Standards of Medical Care in Diabetes -2017", issued by the American Diabetes Association included a recommendation to periodically assess B12 status and, as needed, utilize B12 replacement therapy among diabetes patients receiving metformin. Routine screening, using appropriate B12 assessment methods and interpretation, would enable providers to identify individuals with low B12 levels at an early stage. Prompt treatment with B12 injections or oral supplements may help in reducing the risk of low B12-and HHcy-related sequelae and their associate medical cost. The assessment of B12 status and interpretation of results is not straightforward since several B12 assessment measures are available, including serum/plasma B12, Mean Corpuscular Volume, Homocysteine, Holotranscobalamin II and Methylmalonic Acid. The goal of this manuscript is to 1) Describe available B12 assessment methods including their advantages and disadvantages, 2) Interpret laboratory results of B12 biomarkers, and 3) Discuss available B12 deficiency treatment options. Routine screening, when appropriate B12 status analyses are performed and interpreted, would enable physicians to identify individuals with low B12 at early stage. Treatment with B12 injections or supplements would help in reducing risk of low B12 and HHcy-related symptoms. Such practice would reduce pain and suffering of diabetic patients. It would also decrease medical cost associated with treatments of diabetic co-morbidities. Although metformin is effective in blood glucose control its use is associated with reduced vitamin B12 (B12) concentrations. Results of a recent meta-analysis based on 29 studies with 8,089 participants showed that patients receiving metformin therapy had 2.45 (95% CI 1.74-3.44, p < 0.0001) times higher odds of developing B12 deficiency in comparison to the non-metformin users [3]. There was a mean of 65.8 pmol/L (95% CI 53.6-78.1, p < 0.0001) reduction in the serum B12 level among patients receiving metformin compared to those not receiving metformin treatment. The above results are consistent with the findings published in a systemic review of the impact of metformin on B12 status by Liu, et al. [4]. They found that patients receiving metformin had statistically significantly lower serum B12 concentrations, compared to patients receiving placebo and/or Rosiglitazone (mean difference = 53.93 pmol/L, 95% CI 26.42-81.44, p = 0.0001). The association between metformin use and serum B12 reduction was dose-dependent [4].Based on available evidence of the association between metformin use and reduced B12 levels, the newly published American Diabetes Association's "Standards of Medical Care in Diabetes -2017" included a recommendation to periodically assess B12 status and,

show abstract

Homocysteine is Linked to Macular Edema in Type 2 Diabetes

Abstract: Plasma total homocysteine concentration is independently associated with the occurrence of macular edema in type 2 diabetes. Future prospective studies are warranted to clarify the relationship.

Cited by 12 publications

References 27 publications

Serum neuron‐specific enolase is elevated as a novel indicator of diabetic retinopathy including macular oedema

Serum neuron‐specific enolase is elevated as a novel indicator of diabetic retinopathy including macular oedema

Serum pro‐inflammatory factors as predictors of persistent diabetic macular oedema with limited anatomic response to anti‐VEGF: association with intravitreal injection treatment profiles in real‐world setting

Vitamin B12 for Diabetes Patients Treated with Metformin

Contact Info

Product

Resources

About