Glycemic Control and Coagulation Inhibitors in Diabetic Patients

Abstract

Objective: To investigate the plasma antigenic levels and functional activities of coagulation inhibitors in poorly controlled diabetic patients and the possible effect of good glycemic control on these parameters. Research Design and Methods: Both functional activities and plasma antigenic levels of coagulation inhibitors (antithrombin III, heparin cofactor II, protein C, and protein S) and plasma levels of C4b-binding protein were measured in 28 diabetic patients (13 males, 15 females; 2 IDDM, 26 NIDDM; median age 56.5 years; median duration of diabetes 5.5 years) with poor glycemic control (median HbA_1c 11.8%). Twenty-three healthy subjects were enrolled as controls. Following a 3-month intensification of antihyperglycemic therapy, good glycemic control (HbA_1c <8%) was achieved in 17 patients, and the plasma levels of the same parameters during this period were compared with baseline values. Results: Functional activities and plasma antigenic levels of coagulation inhibitors were comparable in poorly controlled diabetic patients and healthy subjects. In patients achieving good control after 3 months, there was a significant reduction in plasma antigenic levels of protein S (p = 0.005) and C4b-binding protein (p = 0.03); however, no difference could be observed in other parameters. HbA_1c did not show any correlation with plasma antigenic levels or functional activities of coagulation inhibitors either at baseline or at 3 months of good glycemic control. Conclusions: Our findings suggest that in poorly controlled diabetic patients, coagulation inhibitors are not different from healthy controls. Short-term good glycemic control may not exert a profound effect on coagulation inhibitors except protein S and its binding protein, C4b-binding protein.

Prospective study on plasma clotting parameters in diabetic children - no evidence for specific changes in coagulation system

“…On the other hand, inhibitors of coagulation like AT III, protein C or S are inconstantly found decreased in adult diabetics. This is considered to be due to a glycosylation of the AT III molecule (Ceriello et al, 1995;Matsuda et al, 1996) or to an elevation of Cb4 binding protein which reduces the amount of free (and anticoagulant active) protein S (Ceriello et al,1995;Altunbas et al, 1998). For diabetic children, only a few studies are published concerning the influence of the metabolic disorder on the hemostatic system (Koert et al, 1993;Holl et al, 1995).…”

“…In diabetic patients a positive correlation also exists between levels of blood glucose and fibrinogen or factor VII (Ceriello et al, 1995;Carmassi et al, 1992). Impairment of coagulation inhibitors due to non-enzymatic glycosylation is reported for antithrombin III (AT III) (Ceriello et al, 1995) and controversely discussed for protein C and S (Altunbas et al, 1998;Carmassi et al, 1992;Matsuda et al, 1996;Knöbl et al, 1993;Ceriello, 1993).…”

Narushenie sistemy gemostaza u bol'nykh sakharnym diabetom

“…При СД установлены зна чительные изменения в системе ингибиторов коагу ляции -протеин С, протеин S, тромбомодулин, ан титромбин III. В работе [2] обнаружено статистически значимое снижение изначально повышенного уровня протеина S при нормализации углеводного обмена. В работе [46] установлено исходное повышение «обще го» протеина S, при нормальном «свободном» и дос товерное снижение уровня протеина С у больных СД 1 при сравнении с контролем, причем после компен сации углеводного обмена у больных СД полной нор мализации указанных показателей не происходило.…”

The complement system and cardiovascular disease

“…Besides, there are some indications that physical activity and fitness are related to C3 [220,221]. Furthermore, some commonly prescribed anti-hypertensive, lipid-lowering and glucose-lowering drugs were shown to have an effect on C3, C3a or C4BP [124,125,130,[222][223][224][225]. Together, these preliminary observations suggest that C3 levels can be affected by micronutrient intake, diet quality and physical activity independently form the control of body weight, and indicate a potential to influence C3 levels via widely used drugs.…”