title: Meal-induced platelet activation in diabetes mellitus type 1 or type 2 is related to postprandial insulin rather than glucose levels.
abstract: OBJECTIVE
  Postprandial platelet activation was related to postprandial insulin rather than glucose levels in a previous meal insulin study in type 2 diabetes mellitus (T2DM). We therefore compared postprandial platelet activation in type 1 (T1DM) patients without insulin secretion and T2DM patients with high postprandial insulin levels.
  
  
  METHODS
  Patients with T1DM (n=11) and T2DM (n=12) were studied before and 90min after a standardized meal without premeal insulin. Five T1DM patients volunteered for a restudy with their regular premeal insulin. Platelet activation was assessed by flow cytometry, with and without the thromboxane analogue U46619 or ADP, and by whole blood aggregometry (Multiplate®). Effects of insulin (100μU/mL) in vitro were also studied.
  
  
  RESULTS
  Before the meal, glucose, insulin and platelet activation markers other than platelet-leukocyte aggregates (PLAs) were similar in T1DM and T2DM; PLAs were higher in T1DM. Postprandial glucose levels increased more markedly in T1DM (to 22.1±1.4 vs. 11.2±0.6mmol/L) while insulin levels increased only in T2DM (from 24.4±4.4 to 68.8±12.3μU/mL). Platelet P-selectin expression, fibrinogen binding and PLA formation stimulated by U46619 were markedly enhanced (approximately doubled) and whole blood aggregation stimulated by U46619 was increased (p<0.05 for all) after the meal in T2DM patients but not in T1DM patients. The pilot study with premeal insulin in T1DM patients showed postprandial platelet activation when postprandial insulin levels increased. In vitro insulin mildly activated platelets in both groups.
  
  
  CONCLUSIONS
  Postprandial platelet activation via the thromboxane pathway is related to postprandial hyperinsulinemia and not to postprandial hyperglycaemia in patients with diabetes.
authors.affiliation: Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden; Department of Hematology, Coagulation Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Hematology Institute, Thrombosis and Heamostasis Unit, Rabin Medical Center, Beilinsn Hospital, Petach Tikva, Israel.
authors.forename: Galia
authors.initials: G
authors.lastname: Spectre
authors.affiliation: Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Stålesen
authors.affiliation: Department of Molecular Medicine and Surgery, Endocrinology and Diabetology Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden.
authors.forename: Claes-Göran
authors.initials: CG
authors.lastname: Östenson
authors.affiliation: Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Solna, Stockholm, Sweden. Electronic address: Paul.Hjemdahl@ki.se.
authors.forename: Paul
authors.initials: P
authors.lastname: Hjemdahl
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001792:Blood Platelets / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D004435:Eating; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015539:Platelet Activation; D019518:Postprandial Period
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Glucose; Insulin; Platelet activation; Postprandial