Laboratory Parameters of Hemostasis, Adhesion Molecules, and Inflammation in Type 2 Diabetes Mellitus: Correlation with Glycemic Control.

Eleonora Palella,Rossella Cimino,Antonio Brunetti,Antonino S Fiorillo,Marta Greco,Elio Gulletta,Salvatore A Pullano,Daniela P Foti

doi:10.3390/ijerph17010300

Abstract

Background: Type 2 diabetes mellitus (T2DM) is characterized by a prothrombotic state, predisposing to vascular complications. Some related markers, linking thrombophilia to hemostasis and inflammation, however, have been poorly explored in relation to patients’ glycemia. We therefore investigated the association of laboratory hemostatic parameters, circulating adhesion molecules (ADMs), white blood cell (WBC) count, and neutrophil/lymphocyte ratio (NLR) with T2DM and glycemic control. Research design: In this study, 82 subjects, grouped into T2DM patients (n = 41) and healthy individuals (n = 41) were enrolled. To evaluate glycemic control, the T2DM cohort was expanded to 133 patients and sub-classified according to glycated hemoglobin (HbA1c) <7% and ≥ 7% (n = 58 and n = 75, respectively). We assessed glycemia, HbA1c, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), platelet and leukocyte parameters, vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), and selectins (E-, P-, L-). Results: PT % activity, PAI-1, VCAM-1, WBC, and neutrophil counts were significantly higher in T2DM patients than in healthy subjects. Poor glycemic control (HbA1c ≥ 7%) was correlated with increased PT activity (p = 0.015), and higher levels of E-selectin (p = 0.009), P-selectin (p = 0.012), and NLR (p = 0.019). Conclusions: Both T2DM and poor glycemic control affect some parameters of hemostasis, inflammation, and adhesion molecules. Further studies are needed to establish their clinical utility as adjuvant markers for cardio-vascular risk in T2DM patients.

Highlights

Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia, and by a 2–4-fold increased risk of atherosclerotic cardiovascular disease (CVD), leading, in nearly 80% of patients, to a fatal thrombotic event [1,2]
As cell adhesion molecules (ADMs) are implicated in many processes, including inflammation, endothelial dysfunction and thrombosis, we determined the soluble fractions of some of these proteins in the serum of our study population
Among ADMs, a significant difference was observed for vascular cell adhesion molecule-1 (VCAM–1), whose level was increased in diabetic patients compared to healthy controls (Table 1)

Summary

Introduction

Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia, and by a 2–4-fold increased risk of atherosclerotic cardiovascular disease (CVD), leading, in nearly 80% of patients, to a fatal thrombotic event [1,2]. In line with these epidemiological data, several studies have shown that T2DM predisposes to a multifactorial prothrombotic state, in which endothelial dysfunction, platelet hyper-reactivity, alterations of the coagulation cascade, impaired fibrinolysis, as well as chronic, low-grade inflammation, are known to play a major role [3,4,5,6].

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