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

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.  Key Words: Diabetes mellitus, Insulin, Foot ulcer, Fasting blood sugar, Folate, Homocysteine.