Uma Shankar Mishra1, Tity Prabhakaran2
This study intends to assess the changes in the simple routine coagulation parameters in diabetes mellitus and to investigate whether any relationship exists among changes in these coagulation parameters and development of microvascular complication in diabetes mellitus.
MATERIALS AND METHODS
Period of study was from 2010-2012. It was done in M.K.C.G. Medical College with the approval from Berhampur University. It is a case control study. 50 diabetic patients and 50 age and sex matched non-diabetic patients were randomly selected. Simple coagulation parameters like Activated Partial Thromboplastin Time (aPTT), Prothrombin Time (PT), serum fibrinogen, platelet count and Plasminogen Activator Inhibitor-1 (PAI-1) were measured. Statistical study was done using unpaired t-test and analysis and calculations were done using GraphPad software.
Serum fibrinogen was found to be increased in diabetic patients when compared to non-diabetic patients (mean 278 ± 26.9 v/s 232.52 ± 16.5, P value - 0.009, significant). PAI-1 levels was found to be higher among the diabetics when compared to non-diabetics (47.64 ± 8.82 v/s 31.06 ± 7.12, the two-tailed P value is <0.0001, considered extremely significant). Platelet count through within normal limits. It was found to be decreased in diabetic patient when compared to non-diabetic (2.25 ± 0.18 v/s 2.33 ± 0.03, P value - 0.022). Prothrombin Time (PT) (13.15 ± 0.52 v/s 13.04 ± 0.49, P value - 0.28) and PTT (33.04 ± 1.31 v/s 32.99 ± 1.29, P value 0.85, found to be statistically insignificant). Among 50 diabetic patients, 24 had neuropathy, 20 had nephropathy, 10 had retinopathy and 21 had none of these complications. On comparing diabetic patients with microvascular complications and without microvascular complications, significant age difference was observed (59.55 ± 5.06 v/s 51.00 ± 3.31, P=0.003). This probably was a reflection of increase in microvascular complications with increasing duration of diabetes. Serum fibrinogen was found to be increased among diabetic patients with microvascular complications when compared to diabetic patient without microvascular complications (285.28 ± 32.36 v/s 269.86 ± 13.08, P value 0.0449, statistically significant). PAI-1 levels was found to be higher among the diabetics with microvascular complications when compared to diabetics without microvascular complications (52.34 ± 7.40 v/s 41.12 ± 6.31, the two-tailed P value is <0.0001, considered extremely significant). Comparison of diabetic patients with nephropathy and without nephropathy showed significant difference in fibrinogen and PAI-1 levels (292.39 ± 20.19 v/s 269.80 ± 24.43, P value 0.002; 53.67 ± 7.59 v/s 43.62 ± 7.31, P value <0.001). Serum fibrinogen and PAI-1 levels had significant difference on comparison among diabetic patients with neuropathy and without neuropathy (288.92 ± 26.42 v/s 269.46 ± 24.38, p value 0.009; 52.86 ± 7.87 v/s 42.83 ± 6.85, P value <0.001). Comparison of diabetic patients with retinopathy and without retinopathy showed significant difference in fibrinogen levels (249.50 ± 27.19 v/s 286.13 ± 21.64, P value 0.0001). No significant difference in the PAI-1 levels was found among the diabetics with retinopathy when compared to diabetics without retinopathy (48.01 ± 6.95 v/s 47.55 ± 9.30, the two-tailed P value is 0.8846, considered not significant), aPTT and PT showed no significant difference in diabetic patients with and without microvascular complications.
From this simple study, it has been shown that diabetes mellitus is a procoagulant state. Hypercoagulability as evidenced by increased fibrinogen and hypofibrinolysis as evidenced by increased PAI-1 levels. Their levels are elevated in diabetic patients with microvascular complications when compared to those without. Though pathophysiology of microvascular complications not fully understood, it has been shown that there is significant coagulation abnormalities in diabetic patients with microvascular complications.