To study levels of serum fibrinogen in type 2 diabetes mellitus and its association with diabetic microvascular complications
DOI:
https://doi.org/10.18203/2349-3933.ijam20170072Keywords:
Microvascular complications, Serum fibrinogenAbstract
Background: Diabetes mellitus is a hypercoagulable state associated with atherosclerosis leading to development of vascular complications, including microvascular complications.
Methods: In our study a total of 60 diabetic patients with duration of diabetes more than 5 years, attending the OPD/ indoor of SGRDIMSR, Amritsar, Punjaqqb, India were included. They were divided in two groups, group A of 30 patients including diabetics with any of the three microvascular complications (diabetic nephropathy, diabetic retinopathy and diabetic neuropathy) and group B of 30 patients including diabetics without any microvascular complication. Group C comprised of 30 age and sex matched non-diabetic subjects who served as controls. Subjects with liver cirrhosis, malignancy or coagulation disorder were excluded. After taking the consent, detailed history taking and detailed physical examination and relevant investigations were done. The serum fibrinogen (hemostasis marker), HBA1C and UACR (urine albumin creatinine ratio) along with routine investigations were measured.
Results: It was observed that serum fibrinogen levels were significantly higher in diabetic patients (266.16±54.73 mg/dl) as compared to non-diabetic controls (174.66±18.32 mg/dl); p <0.001.Further, serum fibrinogen levels were found to be significantly higher in diabetic patients with microvascular complications (293.43±51.09 mg/dl) as compared to those without microvascular complications (238.90±44.12); p<0.001.
Conclusions: Significantly high serum fibrinogen level was found in diabetic patients as compared to controls and was in positive correlation with development of microvascular complications.
References
Narayan KM, Zhang P, Kanaya AM, Williams DE, Engelgau MM, Imperatore G, et al. Diabetes: the pandemic and potential solutions. In: Disease control priorities in developing countries, 2nd edition. Washington DC: World Bank. 2006:591-603.
Powers AC. Diabetes mellitus. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th edition. New York. McGraw Hill. 2015;419:2422-30.
Fong DS, Aiello LP, Ferris FL, Klein R. Diabetic retinopathy. Diabetes Care. 2004;27:2540-53.
American Diabetes Association: Standards of medical care in diabetes. Diabetes Care. 2007;30:4-41.
Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28:956-62.
Glowinska I, Grochowski J, Malyszko J. Cardiovascular complication in renal replacement therapy. Polish Archives Internal Medicine. 2008;118:7-8.
Obinenche EN, Adam A. Update in Diabetic Nephropathy. Int J Diabetes Metabolism. 2005;13:1-9.
Lin JE, Robbins DC, Bella JN, Palmieri V, Bella JN, Roman MJ. Association of albuminuria with systolic and diastolic left ventricular dysfunction in Type-2 diabetes mellitus. J Am Cardiol. 2003;41(11):2022-8.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977.
Klein R, Klein BEK, Moss SE. Relation of glycemic control to diabetic microvascular complications in diabetes mellitus. Ann Intern Med. 1996;124:90.
Ramsay RC, Goetz FC, Sutherland DER, Mauer SM, Robinson LL, Cantrill HL, et al. Progression of diabetic retinopathy after pancreas transplantation for insulin-dependent diabetes mellitus. N Engl J Med. 1988;318:208.
Viberti GC, Bilous RW, Mackintosh D, Bending JJ, Keen H. Long term correction of hyperglycaemia and progression of renal failure in insulin dependent diabetes. Br Med J. 1983;286:598.
Glowinska I, Grochowski J, Malyszko J. Cardiovascular complication in renal replacement therapy. Polish Archives Internal Medicine. 2008;118:7-8.
Carr ME. Diabetes mellitus: a hypercoagulable state. J Diabetes Complications. 2001;15:44-54.
Kario K, Matsuo T, Kobayashi M, Matsuo M, Sakata T, Miyata T. Activation of tissue factorinduced coagulation and endothelial cell dysfunction in non-insulin-dependent diabetic patients with microalbuminuria. Arterioscler Thromb Vasc Biol. 1995;15:1114-20.
Kvasnicka J, Skrha J, Perusicova J, Kvasnicka T, Markova M, Umlaufova A, et al. Haemostasis, cytoadhesive molecules (sE-selectin and sICAM-1) and inflammatory markers in non-insulin-dependent diabetes mellitus. SbLek. 1998;99:97-101.
Ostermann H, Loo J. Factors of the hemostatic system in diabetic patients: a survey of controlled studies. Haemostasis. 1986;16:386-416.
Carmassi F, Morale M, Puccetti R, Negri F, Monzani F, Navakesi R, et al. Coagulation and fibrinolytic system impairment in insulin dependent diabetes mellitus. Thromb Res. 1992;67:643-54.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:81-90.
Lothar T. Clinical laboratory diagnostics. 1st Edition. TH-Books. Frankfurt, Germany. 1998:621-625.
Ginsberg JM, Chang BS, Matarese RA. Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med.1983;309:1543.
Young MJ, Breddy JL, Veves A, Boulton AJM. The prediction of diabetic neuropathic foot ulcerations using vibration perception thresholds. Diabetes Care. 1994;17:557-60.
Asakawa H, Tokunaga K, Kawakami F. Elevation of fibrinogen and thrombin-antithrombin III complex levels of type 2 diabetes mellitus patients with retinopathy and nephropathy. J Diabetes Complications. 2000;14:121-6.
Knobl P, Schernthaner G, Schnack C. Thrombogenic factors are related to urinary albumin excretion rate in type 1 (insulin dependent) and type 2 (non –insulin -dependent) diabetic patients. Diabetologia. 1993;36:1045-50.
Gabazza EC, Takeya H, Deguchi H, Sumida Y, Taguchi O, Murata , et al. Protein C activation in NIDDM patients. Diabetologia. 1996;39:1455-61.
