We appreciate the comments of Cotellessa et al. (1) as well as their interest in our work. We agree on their results, which confirm our findings. In patients with type 1 diabetes, in the absence of serious complications, the plasmatic concentration of homocysteine is in the low range of the reference values for age-matched control subjects. For this reason, it does not seem to have a predictive role for angiopathy in these types of patients. On the other hand, in patients with type 2 diabetes, especially when signs of nephropathy or macroangiopathy coexist (2), hyperhomocystinemia is a usual finding. In a study carried out in a group of 19 type 1 diabetic adolescents (aged 14 to 18 years), those patients with microalbuminuria (defined as an index albumine/creatinine >3 mg/mmol) (Fig. 1) had basal plasma values of total homocysteine at 7.24 ± 1.62 μmol/l (mean ± SD). After a period of treatment (3–5 months) with captopril (50 mg/day), the microalbuminuria values returned to normal, whereas those of total homocysteine, 7.06 + 1.56 μmol/l, remained similar to those found in basal conditions. These results suggest that only in cases of impaired renal function (3) would an increase of plasma homocysteine take place as an indicator of subclinical atherosclerosis (4).

The data obtained by Cotellessa et al. (1) as well as our results point to the fact that hyperhomocystinemia does not have a predictive value for the microangiopathy in patients with type 1 diabetes.

Figure 1 —
Figure 1 —. Multiple box-plot of plasma total homocysteine (tHcy, μmol/l), microalbuminuria (MA, mg/mmol creatinine), basal (B) versus posttreatment (T). Significant differences (Mann-Whitney U test) were observed only in MA (P < 0.0001).
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Multiple box-plot of plasma total homocysteine (tHcy, μmol/l), microalbuminuria (MA, mg/mmol creatinine), basal (B) versus posttreatment (T). Significant differences (Mann-Whitney U test) were observed only in MA (P < 0.0001).

Figure 1 —
Figure 1 —. Multiple box-plot of plasma total homocysteine (tHcy, μmol/l), microalbuminuria (MA, mg/mmol creatinine), basal (B) versus posttreatment (T). Significant differences (Mann-Whitney U test) were observed only in MA (P < 0.0001).
View largeDownload slide

Multiple box-plot of plasma total homocysteine (tHcy, μmol/l), microalbuminuria (MA, mg/mmol creatinine), basal (B) versus posttreatment (T). Significant differences (Mann-Whitney U test) were observed only in MA (P < 0.0001).

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1
Cotellessa M, Minniti MS, Cerone R, Prigione F, Calevo MS, Lorini R: Low total plasma homocysteine concentrations (tHcy) in patients with type 1 diabetes. Diabetes Care 2001. In press
2
Smulders YM, Rakic M, Slaats EH, Treskes M, Sijbrands EJ, Odekerken DA, Stehouwer CD, Silberbusch J: Fasting and post-methionine homocysteine levels in NIDDM: determinants and correlations with retinopathy, albuminuria, and cardiovascular disease.
Diabetes Care
 
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1999
3
Buysschaert M, Dramais AS, Wallemacq PE, Hermans MP: Hyperhomocystinemia in type 2 diabetes.
Diabetes Care
 
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1816
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2000
4
Vermeulen EGJ, Stehouwer CDA, Twisk JWR, van den Berg M, de Jong SC, Mackaay AJC, van Campen CMC, Visser FC, Jakobs CAJM, Bulterijs EJ, Rauwerda JA: Effect of homocysteine-lowering treatment with folic acid plus vitamin B6 on progresión of subclinical atherosclerosis: a randomised, placebo-controlled trial.
Lancet
 
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517
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2000

Address correspondence and reprint requests to M. Antònia Vilaseca, Servei de Bioquímica, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain.

2001