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Platelet hyper- and hypoaggregability in different microangiopathic complications of diabetes mellitus
1Semmelweis Orvostudományi Egyetem, III. Belgyógyászati Klinika, Budapest, Hungary.
Insights
Diabetic nephropathy is linked to reduced platelet reactivity in vitro, despite evidence of increased platelet activity in vivo. Further research is needed to reconcile these findings in diabetes mellitus patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Diabetes mellitus is associated with vascular complications.
- Platelet function is implicated in diabetic microvascular and macrovascular disease.
- Contradictory findings exist regarding platelet hyper- or hypo-reactivity in diabetes.
Purpose of the Study:
- To investigate in vitro platelet aggregometry in patients with diabetes mellitus and its complications.
- To compare platelet responses to various agonists in diabetic patients with and without nephropathy, neuropathy, and retinopathy.
- To determine if platelet reactivity differs based on diabetes type or azotemia presence.
Main Methods:
- In vitro platelet aggregometry was conducted on 201 patients with diabetes mellitus and 106 controls.
- Platelet aggregation was measured in response to collagen, arachidonic acid, epinephrine, and adenosine diphosphate.
- Patients were stratified based on the presence of diabetic complications like nephropathy, neuropathy, and retinopathy.
Main Results:
- Patients without complications and those with retinopathy showed hyperaggregability to certain agonists.
- Platelet responses to all four stimuli were diminished in patients with diabetic nephropathy (with or without azotemia) compared to controls.
- These altered platelet characteristics were independent of diabetes type.
Conclusions:
- Diabetic nephropathy is characterized by reduced in vitro platelet reactivity (hypoaggregability).
- This contrasts with established in vivo evidence of platelet hyperfunction in diabetes.
- Further investigation is required to elucidate the mechanisms behind this in vitro hypoaggregability in nephropathic diabetic patients.
Abstract:
In vitro platelet aggregometry was performed in 201 patients with diabetes mellitus, and in 106 controls. The complication-free and retinopathic patients showed hyperaggregability to collagen and arachidonic acid, and also to epinephrine and adenosine diphosphate when neuropathy occurred. Patients with nephropathy, both with and without azotemia, had diminished in vitro platelet responses to each of the four stimuli as compared to age- and sex-matched controls. These characteristics were independent of the type of diabetes. It is concluded that diabetic nephropathy is characterized by reduced platelet in vitro reactivity. Further research is necessary to explain in vitro hypoaggregability in contrast to the numerous proofs of in vivo hyperfunction of platelets in diabetes.