Summary
Increased plasma concentrations of various markers of endothelial damage have been
observed in type 1 diabetic patients, particularly in those with microangiopathy.
Objective. To evaluate the effect of nearnormalisation of glycaemic control on different markers
of endothelial injury involved in haemostasis in poorly-controlled type 1 diabetic
patients. Material and Methods. TFPI, thrombomodulin (TM), plasminogen activator inhibitor, tissue-type plasminogen
activator and von Willebrand factor were measured in 14 poorly-controlled type 1 diabetic
patients free of diabetes-related complications (8 men, 6 women; mean age 29.8 ± 9.9
years) before (baseline) and after 3 months of intensive therapy and in 14 sex-, age-and
BMI-matched control subjects. Results. After a mean follow-up of 107 ± 49 days (56-210), Hb A1c decreased from 11.2 ± 2.3 to 6.7 ± 0.7% (p <0.0001). TFPI activity at baseline was
higher than in the control group (126.9 ± 34 vs 92.0 ± 13%, p <0.005) and decreased
after good glycaemic control was achieved (p <0.005), becoming similar to that in
the control group (91.0 ± 16.5%). The TFPI descent correlated with the variations
observed in HbA1c (p <0.05; r = 0.54). TM levels at baseline were significantly higher than in the
control group (42.3 ± 9.1 vs 29.00 ± 10.9; p <0.005) and did not change. The remaining
parameters studied were similar between patients and controls and did not change after
glycaemic optimisation. Conclusions. Optimisation of glycaemic control normalises the increased activity of TFPI but
not the higher TM levels observed in poorly-controlled type 1 diabetic patients without
chronic complications.
Key words
Type 1 diabetes - endothelial markers - TFPI - glycaemic control