Abstract
Thrombotic and antifibrinolytic influence of Diabetes mellitus type 1 (T1DM) on haemostasis have been well demonstrated. There has been no research assessing the influence of poor glycemic control on thrombus formation under flow conditions in vitro or in pregnant type 1 diabetic women to date. This study compared singleton pregnant T1DM women (n = 21) and control pregnant subjects without any metabolic disease (n = 15). The T1DM group was divided into two subgroups of sufficient (SGC-DM; HbA1c ≤6,5%,n = 15) and poor glycaemic control (PGC-DM; HbA1c >6,5%,n = 6). Evaluation of the whole blood thrombogenicity we assessed using T-TAS® at a shear rate of 240 s-1 (Total-Thrombus Analysis System, Zacros, Japan). Blood clot formation initiation time (T10) was significantly shortened in PGC-DM subgroup when compared to SGC-DM subgroup (p = 0,03). The area under the curve (AUC30) of blood clot time formation and the MPV (mean platelet volume) values were substantially higher in the PGC-DM subgroup in comparison to the SGC-DM group (p = 0,03). Negative correlations were noted between HbA1c and T10 values (p = 0,02) and between T10 and MPV values in the T1DM group (p = 0,04). Poor glycaemic control in T1DM subjects triggers a shift towards a prothrombotic and antifibrinolytic state. This phenomenon can be detected using the novel system for quantitative assessment of the platelet thrombus formation process under flow conditions in vitro. The alteration of T-TAS values in PGC-DM subgroup proves that a poor glycemic control-related shift of the equilibrium toward thrombogenesis occurs in this group of patients. Our findings need a further elucidation in research on more massive data sets to be confirmed.
Highlights
Diabetes mellitus (DM) involves a group of chronic metabolic disorders with existing chronic hyperglycemia, defects of insulin action, secretion or both; with altered fat, protein and carbohydrate metabolism [1]
The area under the curve (AUC30) of blood clot time formation and the mean platelet volume (MPV) values were substantially higher in the PGC-DM subgroup in comparison to the SGC-DM group (p = 0,03)
Negative correlations were noted between HbA1c and T10 values (p = 0,02) and between T10 and MPV values in the T1DM group (p = 0,04)
Summary
Diabetes mellitus (DM) involves a group of chronic metabolic disorders with existing chronic hyperglycemia, defects of insulin action, secretion or both; with altered fat, protein and carbohydrate metabolism [1]. As mortality related to vascular disease such as coronary heart disease (CHD) in the general population decreases, it increases in diabetic patients [2]. It is associated with metabolic alterations such as hyperglycemia, dyslipidemia, hypertension and hypercoagulability [4]. Hyperglycemia and chronic hyperinsulinemia in type 2 diabetes mellitus (T2DM), or related to exogenous insulin overdose in T1DM, play an essential role in haemostasis alteration found in DM. Abnormalities in all phases of coagulation occurring in those patients include platelet hyperreactivity, impaired fibrinolysis, endothelial dysfunction, leukocyte activation, chronic low-grade inflammation, increased serum coagulant factors concentration and microparticle involvement [2]
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