HYPERHOMOCYSTEINEMIA FOLLOWING A METHIONINE LOAD IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS AND MACROVASCULAR DISEASE

In the setting of an outpatient diabetic clinic, we determined whether macrovascular disease in patients with diabetes mellitus is associate d with hyperhomocysteinemia (elevated plasma homocysteine [H(e)] conce ntrations) following a methionine load. Methionine-load tests were per formed in 18 healthy controls, 11 diabetics without vascular disease ( five insulin-dependent [IDDM] and six non-insulin dependent [NIDDM]), and 17 diabetics with vascular disease (five IDDM and 12 NIDDM). All s ubjects were male, and there was no significant difference in mean age among the three groups. We measured plasma H(e) concentrations before and 2, 4, 6, 8, and 24 hours after an oral methionine load. Hyperhomo cysteinemia (peak plasma H(e) concentration > control mean +/- 2 SD) o ccurred with significantly greater frequency (seven of 18, 39%) in pat ients with NIDDM as compared with age-matched controls (7%), being mor e common in those with macrovascular disease (five of 12, 41%). The ar ea under the curve (AUC) over 24 hours, reflecting the total period of exposure to H(e), was also elevated with greater frequency in patient s with NIDDM and macrovascular disease (33%) as compared with controls (0%). We conclude that hyperhomocysteinemia is associated with macrov ascular disease in a significant proportion of patients with NIDDM. Fu rther investigation of this association may determine whether hyperhom ocysteinemia contributes to the increased frequency and accelerated cl inical course of vascular disease in patients with diabetes mellitus. Copyright (C) 1996 by W.B. Saunders Company