title: Effects of mealtime insulin aspart and bedtime neutral protamine Hagedorn insulin on postprandial coagulation and fibrinolysis in patients with type 2 diabetes.
abstract: OBJECTIVE
  Acute hyperglycaemia induces coagulation activation in diabetes patients. We hypothesized that rapid-acting insulin has a beneficial postprandial effect on coagulation and fibrinolysis compared with intermediate-acting insulin because of its ability to lower postprandial hyperglycaemia.
  
  
  METHODS
  This was tested in a parallel controlled study in well-controlled patients with type 2 diabetes assigned to bedtime neutral protamine Hagedorn (NPH) insulin (n = 41) or mealtime insulin aspart (n = 37). They were served standard diabetic meals for breakfast (8:00 hours) and lunch (12:00 hours). Blood samples were collected at 7:40 hours (fasting), 9:30, 11:30, 13:30 and 15:30 hours and analysed for glucose, activated factor VII (FVIIa), D-dimer, prothrombin fragment 1+2 (F1+2), tissue plasminogen activator antigen (t-PA) and plasminogen activator inhibitor activity (PAI).
  
  
  RESULTS
  The postprandial glucose response differed significantly between insulin regimens with a postprandial increase on NPH insulin and a decrease on insulin aspart. There was a significant postprandial decrease in F1+2, PAI and t-PA, and no changes in FVIIa and D-dimer, on both insulin regimens, but with no differences between insulin treatment groups.
  
  
  CONCLUSIONS
  The rapid-acting insulin analogue aspart and the intermediate-acting insulin NPH had similar postprandial effects on markers of coagulation activation and fibrinolysis despite different effects on postprandial glucose response.
authors.affiliation: Unit for Thrombosis Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark. ebladbjerg@health.sdu.dk
authors.forename: E M
authors.initials: EM
authors.lastname: Bladbjerg
authors.forename: J E
authors.initials: JE
authors.lastname: Henriksen
authors.forename: S
authors.initials: S
authors.lastname: Akram
authors.forename: J
authors.initials: J
authors.lastname: Gram
mesh_terms: D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D061267:Insulin Aspart / Q000008:administration & dosage* / Q000494:pharmacology; D007336:Insulin, Isophane / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period
chemical_list: D015415:Biomarkers; D007004:Hypoglycemic Agents; D007336:Insulin, Isophane; D061267:Insulin Aspart