The effects of diet and insulin therapy on coagulation factor VII, blood viscosity, and platelet release proteins in diabetic patients with secondary sulphonylurea failure.
The effect of intensified dietary measures and subsequently insulin therapy upon haemorheological measures were studied in Type 2 diabetic patients with secondary sulphonylurea failure. Coagulation factors VIIc and VIIIc, fibrinogen, plasma viscosity, whole blood viscosity, beta-thromboglobulin, platelet factor 4, von Willebrand factor, and euglobulin clot lysis time were measured at baseline, after 3 months intensified dietary therapy and after 4 months insulin therapy. During intensified dietary therapy there was a significant fall in serum cholesterol (p less than 0.05) and a small decrease in weight, but no significant change in blood glucose control. Factor VIIc levels fell significantly (1.22 (SE 0.07) vs 1.42 (0.08) u ml-1, p less than 0.01), and plasma viscosity and whole blood viscosity (23 s-1) also improved (both p less than 0.05). Insulin therapy was instituted with either continuous subcutaneous insulin therapy or twice daily injections of soluble and isophane (NPH) insulin. During this period glycosylated haemoglobin improved (mean (SE) 49.5 (1.4) vs 65.0 (2.1) mmol-HMF mol-Hb-1, p less than 0.001; normal range 29-39 mmol-HMF mol-Hb-1) as did serum triglyceride (p less than 0.01), but weight increased (p less than 0.001). The only haemorheological changes with insulin were increased levels of the platelet release proteins beta-thromboglobulin (37 (3) vs 28 (2) micrograms l-1, p less than 0.01) and platelet factor 4 (median 7.5 (range 3.0-18.0) vs 4.5 (2.0-10.5) micrograms l-1, p less than 0.01).
Jennings
A M
AM
Department of Diabetes, Royal Hallamshire Hospital, Sheffield, UK.
Ford
I
I
Murdoch
S
S
Greaves
M
M
Preston
F E
FE
Ward
J D
JD
D000328:Adult; D001792:Blood Platelets / Q000502:physiology*; D001809:Blood Viscosity; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000178:diet therapy / Q000188:drug therapy; D003927:Diet, Diabetic; D005167:Factor VII / Q000032:analysis*; D005342:Fibrinolysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007958:Leukocyte Count; D008875:Middle Aged; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000032:analysis; D014280:Triglycerides / Q000097:blood; D001620:beta-Thromboglobulin / Q000032:analysis
D002784:Cholesterol; D005167:Factor VII; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D007004:Hypoglycemic Agents; D007328:Insulin; D010978:Platelet Factor 4; D014280:Triglycerides; D001620:beta-Thromboglobulin