Association of Serum Folate and Homocysteine Parameters in Diabetic Patients with and Without Foot Ulcer

Abstract

Objective: To assess the association of serum folate and homocysteine parameters in diabetic patients with and without foot ulcers. Study Design: A comparative study. Place and Duration of the Study: Department of Physiology, Baqai Medical University, Karachi, Pakistan, from June 2023 to 2024. Methodology: Participants were divided into three groups. Group I was healthy control, Group II had diabetic patients without foot ulcers, and Group III had diabetic patients with foot ulcers. Individuals with history of insulin-dependent diabetes and gestational diabetes mellitus (DM) were excluded. ELISA method was used to estimate serum folate and homocysteine. Pearson’s Chi-square test / Fisher’s exact test was used for the association and the Kruskal-Wallis test was used to compare the median of non-normally distributed parameters after checking the assumption of normality using the Shapiro-Wilk’s test. Post-hoc analysis was done using the Dunnett’s T3 test for significant parameters. Results: The median of age, BMI, serum folate, FBS, HbA1c, and homocysteine levels were significantly different across all three groups (p <0.05). The Dunnett’s T3 test for multiple comparisons showed insignificant differences for Folate, HbA1c, and FBS between diabetes and Diabetes with Foot ulcer samples (p >0.05). Spearman’s rank correlation showed significant positive association between HbA1c and homocysteine (r = 0.65, p = 0.001). Conclusion: HbA1c and blood homocysteine levels were correlated significantly among three groups. This indicates that HbA1c and serum homocysteine levels may influence foot ulcer pathogenesis in individuals with Type II DM.