Increased Platelet Activation leads to CV Risk in Adolescents with Type 2 Diabetes

Adolescents with type 2 diabetes are at risk of atherosclerosis and cardiovascular disease early on in life…. 

There is well established data that diabetes, platelet hyperactivity, and cardiovascular disease (CVD) are causes of mortality in adults with type 1 and type 2 diabetes. The purpose of this pilot study was to establish whether the same connection was present in adolescents as in adults with the comparison of non-diabetic control subjects. The study examined the expression of the surface and soluble platelet activation markers.

In-vivo platelet activation was compared in four different groups of adolescents aged 12-18 years. These adolescents groups comprised of type 1diabetes (T1D, n=15), type 2 diabetes (T2D, n=15), control subjects with normal BMI (n=14), and control subjects that are obese/overweight (n=13). Subjects with Prader-Willi syndrome, hypothyroidism, alcohol or drug abuse, congenital CVD, pregnancy, and use of glucocorticoids, lipid lowering agents, or platelet inhibitory agents were all excluded from this study. Type 1 and 2 diabetes was classified according to the Canadian Diabetes association criteria. Measurements of platelet surface and soluble activation markers were performed using the FACSCalibur flow cytometer. Results were shown as percentage of platelets expressing CD62P and CD63 platelet surface antigen as well as PAC-1 monoclonal antibodies.

Results show that there were significantly higher platelet activation markers in T2D adolescents when compared with either obese or normal control group (P<0.05). There was a small difference in platelet activation between T1D adolescents and the two control group, although the pattern was leaning towards an increase in activation markers for T1D. There were no differences in platelet activation markers between the non-diabetic groups.

The study shows that in-vivo platelet activation is increased in adolescents with T2D, which can be a potential cause of atherosclerosis, thrombosis, and other cardiovascular diseases in early adulthood. Although it was a small study, it brings awareness to the fact that a more aggressive approach should be undertaken when modifying therapeutic interventions for T2D in adolescents.

• Increased numbers of circulating activated platelets have been reported in adults with T2D, with activation markers expression being highest in patients with detectable vascular disease.
• Platelet activation markers are increased in adolescents with T2D, which can lead to cardiovascular problems in early adulthood
• Adolescents with T2D should be treated with the same caution and attentiveness as any adult would be treated to reduce risk of early adulthood cardiovascular disease.

Israels SJ, McNicol A, Dean HJ, et al. Markers of Platelet Activation Are Increased in Adolescents With Type 2 Diabetes. Diabetes Care. 2014 June 4.