Folic acid lowers homocysteine levels in T2DM

Folic acid supplementation in individuals with type 2 diabetes mellitus (T2DM) helps mitigate the risk of cardiovascular diseases (CVD) by way of reducing homocysteine concentrations, according to a meta-analysis.

Researchers searched multiple online databases for studies in which the effects of folate on inflammation and homocysteine in T2DM was explored. Random-effect models were used to moderate heterogeneity, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline was followed in evaluating the overall certainty of evidence across the studies.

Nine trials met the inclusion criteria and were included in the meta-analysis. The total population comprised 426 participants with T2DM, of which 225 patients received supplements and 201 received placebo. The supplements were either folate or folic acid, with doses ranging from 0.25 mg to 10 mg, administered for a period ranging from 2 weeks to 28 weeks. 

Pooled data showed that compared with placebo, folic acid supplementation led to a significant reduction in homocysteine levels (standardized mean difference [SMD], −1.53, 95 percent confidence interval [CI], −2.14 to −0.93; p<0.05), with a large effect size.

With respect to inflammation, folic acid supplementation had a medium marginal effect size on C-reactive protein (SMD, −0.68, 95 percent CI, −1.34 to −0.01; p=0.05). There was no significant effect seen for tumour necrosis factor-α (SMD, −0.86, 95 percent CI, −2.65 to 0.93; p=0.34) and interleukin-6 (SMD, −0.04, 95 percent CI, −1.08 to 1.01; p=0.95).