POSTMEAL COAGULATION ACTIVATION IN DIABETES-MELLITUS - THE EFFECT OF ACARBOSE

It has been previously demonstrated that hyperglycaemia activates haem ostasis; diabetes mellitus is considered a thrombosis-prone state. Aca rbose, by inhibiting dietary carbohydrate absorption, reduces post-mea l hyperglycaemia. In this study we. evaluated the effect of post-meal hyperglycaemia on two markers of coagulation activation: prothrombin f ragments 1+2 and D-dimer. Seventeen non-insulin-dependent diabetic pat ients maintained on diet therapy alone were randomly assigned to recei ve - with a cross-over study design - acarbose (100 mg orally) or plac ebo before a standard meal. Blood samples for measurement of plasma gl ucose, insulin, prothrombin fragments 1+2 and D-dimer were drawn at 0, 60, 120 and 240 min. After both placebo and acarbose, hyperglycaemia and hyperinsulinaemia which followed a standard meal were accompanied by a significant increase of plasma concentration of prothrombin fragm ents 1+2 and D-dimer in comparison to their baseline values. Acarbose administration significantly reduced the rise of glucose, insulin, pro thrombin fragments 1+2 and D-dimer from 0 to 240 min in comparison to placebo. We conclude that post-meal hyperglycaemia, at the level reach ed by many diabetic patients on diet therapy alone, induces a coagulat ion activation, Acarbose, by decreasing post-meal hyperglycaemia, may be useful in reducing meal-induced activation of haemostasis in diabet ic patients.