People with diabetes are at risk of having high homocysteine as abnormally raised body insulin levels (which control the sugar content of the blood) make it very difficult for the body to lower and maintain healthy levels of homocysteine.

In addition, homocysteine has been shown to have a far more powerful effect on diabetics than non-diabetics. Elevated homocysteine combined with diabetes results in a 90% increased risk of mortality within 5 years in comparison to non-diabetics with high homocysteine levels.