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Elevated platelet activation in type I diabetics with chronic complications under long-term near-normoglycemic
D Tschoepe1, H Ostermann, A Huebinger
1Diabetes Research Institute, Heinrich Heine University, Düsseldorf, FRG.
Insights
Platelet activation remains elevated in type 1 diabetes patients even with intensive blood sugar control. This persistent platelet hyperactivity may indicate an increased risk for vascular complications in diabetic patients.
Area of Science:
- Endocrinology
- Hematology
- Diabetology
Background:
- A prethrombotic state, characterized by hyperactive platelets, is implicated in diabetic complications.
- The efficacy of intensive metabolic control in reducing platelet activation in diabetes is debated.
Purpose of the Study:
- To investigate whether intensive glycemic control normalizes in vivo platelet activation in type 1 diabetes.
- To assess plasma markers of platelet activation in long-term type 1 diabetic patients under near-normoglycemic conditions.
Main Methods:
- Study included 64 type 1 diabetic patients with microangiopathy and at least 18 months of intensive treatment.
- Measured plasma levels of platelet factor 4 and beta-thromboglobulin.
- Compared results with healthy controls and analyzed correlations with metabolic parameters.
Main Results:
- Platelet factor 4 and beta-thromboglobulin levels were significantly elevated in type 1 diabetics compared to controls (p <= 0.05).
- No significant correlations were found between platelet activation markers and metabolic parameters (blood glucose, HbA1, lipids) or treatment duration.
Conclusions:
- In vivo platelet activation persists in type 1 diabetes patients despite long-term intensive glycemic control.
- Elevated platelet activation may serve as an indicator of increased vascular complication risk in these patients.
Abstract:
A prethrombotic state with altered, hyperactive platelets may contribute to the development of diabetic late complications. Whether increased platelet 'in vivo' activation can be reduced by tight metabolic control is controversial. We studied plasma markers of platelet activation in 64 long-term, microangiopathic type I diabetics after at least 18 months of intensive treatment for near-normoglycemia. Both platelet factor 4 and beta-thromboglobulin proved to be significantly (p less than or equal to 0.05) elevated in comparison with healthy controls: 15.8 (sdf 2)/77.6 (sdf 1.9) vs. 8.9 (sdf 1.6)/45.1 (sdf 2) ng/ml (sdf = standard deviation factor). We found no significant correlations with any metabolic parameter (actual blood glucose, mean blood glucose, HbA1, triglycerides, cholesterol) or with the duration of intensive treatment. It is therefore concluded, that platelet 'in vivo' activation takes place in type I diabetics even after long-term near-normoglycemic control. This deviation could be regarded as indicator of an additional risk for the development of vascular complications.