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Thromb Haemost 1994; 71(05): 692-697
DOI: 10.1055/s-0038-1642506
Review Article
Schattauer GmbH Stuttgart

Haemostatic Abnormalities Persist Despite Glycaemic Improvement by Insulin Therapy in Lean Type 2 Diabetic Patients

Paul Knöbl
1   The Dept. Med. II, University of Vienna, Vienna, Austria
,
Guntram Schernthaner
2   The Dept. Med. I, Rudolfstiftung Hospital, Vienna, Austria
,
Christoph Schnack
2   The Dept. Med. I, Rudolfstiftung Hospital, Vienna, Austria
,
Peter Pietschmann
1   The Dept. Med. II, University of Vienna, Vienna, Austria
,
Sylvia Proidl
1   The Dept. Med. II, University of Vienna, Vienna, Austria
,
Rudolf Prager
1   The Dept. Med. II, University of Vienna, Vienna, Austria
,
Thomas Vukovich
1   The Dept. Med. II, University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Received: 14 May 1993

Accepted after revision 16 February 1993

Publication Date:
26 July 2018 (online)

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Summary

Diabetes mellitus is associated with disturbances of the haemostatic system, which might contribute to the development of diabetic vascular disease. We investigated the effect of metabolic improvement by insulin therapy on the haemostatic system in 61 patients with type 2 diabetes mellitus and secondaxy sulfunyluiea failure compared with 45 healthy control subjects matched for age, sex and BMI. Median age was 65, median diabetes duration 10 years. Median HbA1c (10%) and fructosamine (4.0 mM) levels were elevated before induction of therapy and decreased significantly within 6 months of insulin treatment to 7.5% and 3.0 mM, respectively (p <0.0001). Compared with control subjects, median plasma levels of fibrinogen (317 vs 286 mg/dl), coagulation factor VII activity (1.1 vs 0.89 U/1), von Willebrand factor (1.6 vs 1.3 U/1), D-dimer (105 vs 86 jug/1), protein C:Ag (1.24 vs 0.95 U/1), total protein S:Ag (1.15 vs 0.91 U/1), and antithrombin III activity (1.17 vs 1.08 U/1) were significantly elevated. Levels of free protein S were not different from control values. No significant decline of coagulation parameters could be recorded during insulin therapy. Patients with diabetic vasculopathy had higher levels of D-dimer than those without (133 vs 76 μg/1 before, 109 vs 88 μg/1 during therapy), whereas the other haemostatic parameters were not different. Our data indicate a significant activation of the coagulation system in diabetic patients with secondary failure to sulfonylurea drugs, with signs of a prethrombotic state and endothelial cell disturbance. Induction of insulin therapy results in a significant improvement of glycaemic and lipid metabolism, but the persisting enhanced activity state of the haemostatic system might contribute to the increased cardiovascular mortality of type 2 diabetic patients.

 

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