title: Platelet reactivity in type 2 diabetes mellitus: a comparative analysis with survivors of myocardial infarction and the role of glycaemic control.
abstract: Patients with type 2 diabetes mellitus exhibit considerable platelet dysfunction, though this is poorly characterized in patients with diabetes taking aspirin for the primary prevention of cardiovascular events. We sought to compare platelet function in this patient population with that of a high-risk group of non-diabetic subjects with a history of previous myocardial infarction (MI), and to assess whether glycaemic control impacts on platelet function.
  
  
  METHODS
  Platelet aggregation was measured in response to incremental concentrations of five platelet agonists using light transmission aggregometry. All patients were taking aspirin, and aspirin insensitivity was defined as ≥ 20% arachidonic acid (AA) mediated aggregation. Patients with diabetes were divided according to glycaemic control (HbA(1c)): optimal ≤ 6.5, good 6.6-7.4 and suboptimal ≥ 7.5%.
  
  
  RESULTS
  In total, 85 patients with type 2 diabetes and 35 non-diabetic patients with previous MI were recruited. Compared to MI patients, diabetes patients had increased aggregation in response to multiple concentrations of epinephrine, collagen, adenosine diphosphate and AA. Aspirin insensitivity was more common in type 2 diabetes (15% vs. 0%, p=0.037). Platelet aggregation was increased in response to several agonists patients with suboptimal glycaemic control compared to patients with optimal control. Aspirin insensitivity was also more common in patients with suboptimal glycaemic control compared to those with good or optimal control (26.0% vs. 8.3% vs. 4%, p=0.04).
  
  
  CONCLUSIONS
  Patients with type 2 diabetes mellitus, without proven vascular disease, exhibit platelet dysfunction and have increased platelet aggregation and aspirin insensitivity compared to non-diabetic patients with previous MI. Platelet dysfunction in diabetes is more severe in patients with suboptimal glycaemic control.
authors.affiliation: Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland , Dublin , Ireland. darrenmylotte@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Mylotte
authors.forename: G F
authors.initials: GF
authors.lastname: Kavanagh
authors.forename: A J
authors.initials: AJ
authors.lastname: Peace
authors.forename: A F
authors.initials: AF
authors.lastname: Tedesco
authors.forename: D
authors.initials: D
authors.lastname: Carmody
authors.forename: M
authors.initials: M
authors.lastname: O'Reilly
authors.forename: D P
authors.initials: DP
authors.lastname: Foley
authors.forename: C J
authors.initials: CJ
authors.lastname: Thompson
authors.forename: A
authors.initials: A
authors.lastname: Agha
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Kenny
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016718:Arachidonic Acid / Q000494:pharmacology; D001241:Aspirin / Q000008:administration & dosage*; D001786:Blood Glucose / Q000032:analysis; D001792:Blood Platelets / Q000187:drug effects; D003094:Collagen / Q000494:pharmacology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D010974:Platelet Aggregation / Q000187:drug effects*; D012720:Severity of Illness Index; D017741:Survivors
chemical_list: D000244:Adenosine Diphosphate; D016718:Arachidonic Acid; D001241:Aspirin; D001786:Blood Glucose; D003094:Collagen; D004837:Epinephrine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human