Association between glycemic control and serum fibrinogen levels in type 2 diabetes mellitus patients
Keywords:Glycated haemoglobin, Serum fibrinogen, Serum total cholesterol, Serum triglycerides, Serum high density lipoprotein cholesterol, Serum low density lipoprotein cholesterol
Background: Poor glycemic control has been reported to be associated with increased vascular complications in diabetes mellitus (DM) patients. High fibrinogen level has been described as an independent risk factor for cardiovascular diseases. High fibrinogen has been suggested to be involved in the excess rate of cardiovascular diseases in patients with type 2 DM. The present study was undertaken to find correlation between glycemic control and plasma fibrinogen level in patients with type 2 DM.
Methods: Three hundred ten patients aged ≥30 years of either sex were included in this cross sectional study. Estimation of glycated haemoglobin (HbA1c), serum fibrinogen, serum total cholesterol (TC), serum triglycerides (TG), serum high density lipoprotein (HDL) cholesterol, and serum low density lipoprotein (LDL) cholesterol was done. Categorical and continuous variables were tested using Chi-Square test/Fisher’s exact test and unpaired ‘t’ test respectively. Pearson’s correlation was used to study correlation between serum fibrinogen levels and HbA1c, Body mass index (BMI), TC, LDL cholesterol, HDL cholesterol, and TG.
Results: Mean serum fibrinogen levels were significantly higher in DM patients whose HbA1c, LDL cholesterol and TG levels were higher. Correlation between serum fibrinogen was 0.59, and 0.45 with HbA1c, and BMI respectively. Multivariate step-wise regression analysis showed higher HbA1c and higher BMI were the independent and significant predictors of higher serum fibrinogen levels. HbA1c was the stronger predictor of serum fibrinogen than BMI.
Conclusions: Fibrinogen levels were independently associated with HbA1c value in patients with type 2 DM.
Zhao Y, Zhang J, Zhang J, Wu J. Diabetes mellitus is associated with shortened activated partial thromboplastin time and increased fibrinogen values. PLoS One. 2011;6:e16470.
Stec JJ, Silbershatz H, Tofler GH, Matheney TH, Sutherland P, Lipinska I, et al. Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the Framingham Offspring Population. Circulation. 2000;102:1634-8.
Kuusisto J, Mykkänen L, Pyörälä K, Laakso M. NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes. 1994;43:960-7.
Kafle D, Shrestha P. Study of fibrinogen in patients with diabetes mellitus. Nepal Med Coll J. 2010;12:34-7.
Maple-Brown LJ, Cunningham J, Nandi N, Hodge A, O'Dea K. Fibrinogen and associated risk factors in a high-risk population: urban Indigenous Australians, the DRUID Study. Cardiovascular Diabetology. 2010;9:69.
Meade TW, Brozovic M, Chakrabarti RR, Haines AP, Imeson JD, Mellows S, et al. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. The Lancet. 1986;328:533-7.
Kannel WB, Wolf PA, Castelli WP, D'Agostino RB. Fibrinogen and risk of cardiovascular disease. The Framingham Study. JAMA. 1987;258:1183-6.
Kannel WB, D'Agostino RB, Wilson PW, Belanger AJ, Gagnon DR. Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience. Am Heart J. 1990;120:672-6.
Ernst E, Resch KL. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature. Ann Intern Med. 1993;118:956-63.
Jain A, Gupta H, Narayan S. Hyperfibrinogenemia in patients of diabetes mellitus in relation to glycemic control and urinary albumin excretion rate. J Association Physicians India. 2001;49:227-30.
Expert Panel on Detection E. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.
Haffner SM. Dyslipidemia management in adults with diabetes. Diabetes care. 2004;27:S68-71.
Ziemer DC, Kolm P, Weintraub WS, Vaccarino V, Rhee MK, Twombly JG, et al. Glucose-independent, black-white differences in hemoglobin A1c levels: a cross-sectional analysis of 2 studies. Annals Int Med. 2010;152:770-7.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35:121-6
Mahendra J, Kumar SD, Anuradha TS, Talikoti P, Nagaraj RS, Vishali V. Plasma fibrinogen in type 2 diabetic patients with metabolic syndrome and its relation with ischemic heart disease (IHD) and retinopathy. J Clin Diag Res. 2015;9:BC18.
Dhawale S, Jayant S, Gupta AK. Serum fibrinogen level in type 2 diabetes mellitus patients. Int J Adv Med. 2017;3:83-7.
Mohan G, Kaur R, Aggarwal A, Singh P. To study levels of serum fibrinogen in type 2 diabetes mellitus and its association with diabetic microvascular complications. Int J Adv Med. 2017;4:10-4.
Bembde AS. A study of plasma fibrinogen level in type-2 diabetes mellitus and its relation to glycemic control. Indian J Hematol Blood Transfus. 2012;28:105-8.
Saini PK, Saluja M, Meena SR, Meena SB. Study of plasma fibrinogen level in type 2 diabetes mellitus and its association with glycemic control. J Assoc Physicians India. 2016;64:95.
Bruno G, Cavallo-Perin P, Bargero G, Borra M, D'Errico N, Pagano G. Association of fibrinogen with glycemic control and albumin excretion rate in patients with non-insulin-dependent diabetes mellitus. Ann Intern Med. 1996;125:653-7.
Mohan V, Shah S, Saboo B. Current glycemic status and diabetes related complications among type 2 diabetes patients in India: data from the A1chieve study. J Assoc Physicians India. 2013;61:12-5
Unnikrishnan R, Anjana RM, Deepa M, Pradeepa R, Joshi SR, Bhansali A, et al. Glycemic control among individuals with self-reported diabetes in India-the ICMR-INDIAB study. Diab Technol Therap. 2014;16:596-603.
Mittal S, Dwivedi RN, Lalchandani A, Puri A, Mishra P. Correlation of fibrinogen as an indicator of both long and short term glycemic control in diabetes. JAPI. 2002;50:129-30.
De Feo P, Gaisano MG, Haymond M. Differential effects of insulin deficiency on albumin and fibrinogen synthesis in humans. J Clin Investigation. 1991;88:833-40.
Danesh J, Lewington S, Thompson SG, Lowe GD, Collins R, Kostis JB, et al. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA. 2005;294:1799-809.
Sinning JM, Bickel C, Messow CM, Schnabel R, Lubos E, Rupprecht HJ, et al. Impact of C-reactive protein and fibrinogen on cardiovascular prognosis in patients with stable angina pectoris: the Athero Gene study. Eur Heart J. 2006;27:2962-8.
Kaptoge S, Thompson SG, Danesh J, Emerging Risk Factors Collaboration. C-reactive protein, fibrinogen, and cardiovascular risk. N Engl J Med. 2013;368:85-6.
Park CS, Ihm SH, Yoo KD, Kim DB, Lee JM, Kim HY, et al. Relation between C-reactive protein, homocysteine levels, fibrinogen, and lipoprotein levels and leukocyte and platelet counts, and 10-year risk for cardiovascular disease among healthy adults in the USA. Am J Cardiol. 2010;105:1284-8.
Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998;279:1477-82.
Sabeti S, Exner M, Mlekusch W, Amighi J, Quehenberger P, Rumpold H, et al. Prognostic impact of fibrinogen in carotid atherosclerosis: nonspecific indicator of inflammation or independent predictor of disease progression?. Stroke. 2005;36:1400-4.
Green D, Foiles N, Chan C, Schreiner PJ, Liu K. Elevated fibrinogen levels and subsequent subclinical atherosclerosis: the CARDIA study. Atherosclerosis. 2009;202:623-31.
De Luca G, Verdoia M, Cassetti E, Schaffer A, Cavallino C, Bolzani V, et al. High fibrinogen level is an independent predictor of presence and extent of coronary artery disease among Italian population. J Thromb Thrombolysis. 2011;31(4):458-63.
Temelkova-Kurktschiev T, Koehler C, Henkel E, Hanefeld M. Leukocyte count and fibrinogen are associated with carotid and femoral intima-media thickness in a risk population for diabetes. Cardiovasc Res. 2002;56:277-83.
Willeit P, Thompson SG, Agewall S, Bergström G, Bickel H, Catapano AL, et al. Inflammatory markers and extent and progression of early atherosclerosis: Meta-analysis of individual-participant-data from 20 prospective studies of the PROG-IMT collaboration. Eur J Prev Cardiol. 2016;23:194-205.
Chuang SY, Bai CH, Chen WH, Lien LM, Pan WH. Fibrinogen independently predicts the development of ischemic stroke in a Taiwanese population: CVDFACTS study. Stroke. 2009;40:1578-84.
Shankar A, Wang JJ, Rochtchina E, Mitchell P. Positive association between plasma fibrinogen level and incident hypertension among men: population-based cohort study. Hypertension. 2006;48:1043-9.