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Item
#12
Improved
Glycemic Control of Type 2 Diabetes Reduces Risk of Thrombotic
Complications
Hyperglycemia
can enhance thrombogenicity
The
more that HbA1c levels are reduced, the greater the reduction in
thrombus formation, according to a double-blind study involving an
insulin sensitizer in patients with type 2 diabetes.
All
40 patients studied, who had elevated HbA10 values (>7.5%)
despite dietary modification and treatment with insulin or
sulfonylurea, or both, were randomized to receive a placebo or
troglitazone (800 mglday) for 3 months, during which their
previous regimen was continued.
Studies
at baseline and at 3 months included thrombogenicity assessment
using a recently developed ex vivo perfusion chamber that allows
histologic measurement of thrombus formation over porcine sortie
tunica media; the effect of clinically significant glycemic
control (defined as HbA1ç reduction of 0.5% or more)
on thrombogenicity was measured as the change in the area of the
thrombus at baseline and at 3 months.
Patients
in both the trogiftazone (74%) and placebo (46%) groups frequently
experienced significant glycemic control, which in turn was the
only independent variable associated with significant thrombus
reduction. Patients who had no glycemic improvement showed no
change in thrornbogenicity. However, the possibility that
troglitazone had an antithrombotlc effect In addition to glucose
lowering cannot be excluded by this study design.
The
investigators noted that their findings contrast with those of
previous groups, who had failed to find a link between Improved
glycemic control and reduced hypercoagulability in patients with
diabetes. They suggested that techniques previously used (such as
in vitro platelet aggregation and measurement of plasma
proteins) cannot accurately assess hypercoagulability. Rather,
they argued that the perfusion chamber technique makes such
measurements possible by mimicking the high-shear conditions
present in a mildly stenotic coronary artery
The
findings support the hypothesis that hyperglycemia can enhance
thrombogenicity (perhaps by accelerating the formation of
advanced glycosalated end products), and conversely that giycemlc
control can inhiblt thrombogenicity. More broadly, they lend
credence to the view that the hypercoaguuuulable state should be
added to the list of risk factors for thrombotic complications of
atherosclerosis in type 2 diabetes.
Ounde
Jl et al. Blood thrombogenicity in type 2 diabetes patients is
associated with glycemic control. Jam Coll Cardiol.
2001:38:1307-1312.
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