ALTERATION OF OXIDE REDUCTIVE AND HEMOSTATIC FACTORS IN TYPE-2 DIABETICS

Objective. To assess any pathogenic role of radical activity and haemo static alteration in the early cardiovascular disease of microalbuminu ric type 2 diabetics (non-insulin dependent). Design. A selected cohor t of type 2 diabetics was identified, divided according to urinary alb umin excretion and compared with a healthy control group depending on some haemostatic factors and radical activity. Setting. All the subjec ts were studied as outpatients. Subjects. Eighty diabetics and 84 heal thy controls were interviewed and underwent blood tests to exclude sta ndard cardiovascular risk factors before follow up. Main outcome measu res. The subjects were males, age range 43-55 years, and divided accor ding to albumin excretion (microalbuminuria > 30-200 mg L(-1); normoal buminuria < 15 mg L(-1)). The mean duration of diabetes referred by th e patients was 9.3 years in albuminuric and 11.1 years in normoalbumin uric patients with a good control of plasma glucose level. Neither the diabetics nor the control group showed clinical evidence of renal and cardiovascular diseases. Results. Microalbuminuric patients presented elevated malondialdehyde concentration, glutathione peroxidase activi ty, phospholipidic fatty acid levels, fibrinogen, plasminogen activato r inhibitor, tissue plasminogen activator and von Willebrand factor co mpared with normoalbuminuric patients and controls. More collagen was required in microalbuminuric diabetics than in normoalbuminurics and c ontrols. Conclusions. Our results confirm that both free radical activ ity and changes in haemostatic factors can be observed in type 2 diabe tes and particularly in patients with albuminuria. Our very selected s eries with short duration, good control of diabetes and lack of clinic al evidence of cardiovascular disease may suggest that these abnormali ties develop earlier and may be associated with, and/or implicated in, the pathogenesis of microvascular complications which can be related to a higher and early cardiovascular morbidity and mortality rate in m icroalbuminuric diabetics.