Phenformin-induced lactic acidosis in an older diabetic patient: a recurrent drama (phenformin and lactic acidosis).

sociated with albuminuria in type 2 diabetic patients (4). To the best of our knowledge, however, it is not clear whether serum homocysteine is associated with TNF receptor in type 2 diabetic patients. The aim of the present study was therefore to investigate the relationships between serum homocysteine and TNF receptor in patients with type 2 diabetes. Fifty nonobese Japanese type 2 diabetic patients were studied. Their BMI, HbA1c, and serum creatinine were 22.6 0.3 kg/m2 (range 17.6 –26.2), 7.8 0.2% (5.5–12.3), and 0.70 0.02 mg/dl (0.46–0.98), respectively. They had not been treated with insulin or any medications known to alter homocysteine level. In conjunction with homocysteine, systolic and diastolic blood pressure, HbA1c, glucose, lipids, serum creatinine, TNF, sTNF-R1, and sTNF-R2 were measured after an overnight fast. With univariate analysis, serum homocysteine was positively correlated with age (r 0.361, P 0.012), diabetes duration (r 0.292, P 0.045), serum creatinine (r 0.623, P 0.001), sTNF-R1 (r 0.415, P 0.005), and sTNF-R2 (r 0.371, P 0.01). Other variables including TNF, however, were not associated with homocysteine. Multiple regression analyses showed that serum homocysteine was independently associated with serum creatinine (F 20.1) and sTNF-R1 (F 6.9), which explained 49.3% of the variability of homocysteine. Thus, TNF system activity may be responsible for the evolution of atherosclerosis induced by homocysteine in nonobese Japanese type 2 diabetic patients.