title: The effect of near-normoglycaemic control on plasma levels of coagulation factor VII and the anticoagulant proteins C and S in insulin-dependent diabetic patients.
abstract: The present prospective follow-up study was made to study the effect of glycaemic regulation on levels of factor VII, protein C and protein S in 15 insulin-dependent diabetic patients without manifestations of vascular disease. Patients were tested before and after 8 weeks of 'metabolic' intervention, whereby a near-normoglycaemic state was achieved. At baseline, values of cross-linked fibrin degradation products (XL-FDP) and levels of 'total' protein S were significantly increased and protein C values were decreased in the diabetic patients when compared to control subjects, whereas levels of factor VII and 'free' protein S were near normal. After 'metabolic' intervention a decrease of all haemostatic parameters were recorded, however XL-FDP levels did not decline to control levels and the imbalance of factor VII and protein C persisted. When patients with newly diagnosed diabetes (n = 8) were compared to those with long-term disease (n = 7) higher levels of factor VII, protein C and protein S were recorded in the latter group before and after metabolic intervention; at baseline the differences reached statistical significance for factor VII and protein S, and remained significant for factor VII after metabolic intervention. Before and after intervention XL-FDP levels were higher in patients with newly diagnosed disease than in patients with long-term diabetes. The correlation analysis revealed positive correlations of factor VII, protein C and protein S to cholesterol and triglycerides, of protein S to all glycaemic control parameters, negative correlations of protein C to glucose, and of XL-FDP to factor VII, protein C and protein S. The results indicate an imbalance of haemostasis towards thrombophilicity in insulin-dependent diabetic patients, not completely correctable by glycaemic control.
authors.affiliation: Department of Medicine I, Rudolfstiftung Hospital Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Schernthaner
authors.forename: T
authors.initials: T
authors.lastname: Vukovich
authors.forename: P
authors.initials: P
authors.lastname: Knöbl
authors.forename: U
authors.initials: U
authors.lastname: Hay
authors.forename: M M
authors.initials: MM
authors.lastname: Müller
mesh_terms: D000328:Adult; D001777:Blood Coagulation; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005167:Factor VII / Q000378:metabolism*; D005500:Follow-Up Studies; D006023:Glycoproteins / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism*; D017293:Protein S
chemical_list: D001786:Blood Glucose; D006023:Glycoproteins; D007328:Insulin; D011486:Protein C; D017293:Protein S; D005167:Factor VII