THE FIBRINOLYTIC RESPONSE TO EXERCISE AT DIAGNOSIS AND AFTER 12 MONTHS IN PATIENTS WITH TYPE-2 DIABETES-MELLITUS

Objective: To determine fibrinolytic activity and exercise stimulated fibrinolytic capacity in patients with type 2 diabetes mellitus at dia gnosis and after 12 months treatment aimed at improving glycaemic cont rol. Subjects: Thirteen patients referred to the hospital diabetic out -patient department with a new diagnosis of type 2 diabetes mellitus w ere selected for study. Methods: Basal fibrinolytic activity anal exer cise stimulated fibrinolytic capacity were measured at diagnosis and a fter 12 months of interventional therapy. Results: Compared with contr ols basal fibrinolytic activity was depressed in the diabetic patients due to increased levels of PAI-1:Ag 15.1 (4.6-20) versus 8.4 (3.0-9.9 ) ng/ml, p<0.05 and PAI, 17.6 (10.9-26.8) versus 6.6 (4.8-13.6) IU/ml, p<0.01. PAI was related to fasting plasma insulin levels r=0.8, p<0.0 01 and body mass index r=0.7, p<0.01 at diagnosis, but not triglycerid es or blood pressure. Median t-PA:Ag was also elevated in the diabetic group 9.8 (6.3-12.1) versus 4.5 (3.1-7.1) ng/ml, p<0.001. The percent age change in ECLT with exercise was inversely proportional to the deg ree of insulin resistance r=-0.08, p<0.001 and fasting plasma insulin r=-0.65, p=0.02, at diagnosis. Despite an improvement in glycosylated haemoglobin, 8.7 (1.8) to 7.0 (1.2) %, p=0.008, over 12 months, the EC LT increased from 290 (220-315) to 360 (316-375) mins, p<0.05. This wa s associated with an increase in the PAI-1:Ag/t-PA:Ag ratio from 1.92 (1.63) to 2.48 (0.97), p=0.025. Although t-PA release due to exercise was reduced in the diabetic group (38%) compared to non-diabetic contr ols (82 %) p<0.001, similar results were found after 12 months 54.5 % to those at diagnosis 38 %, (NS). Conclusion: This study has shown tha t in a selective group of type 2 diabetic patients, exercise stimulate d fibrinolytic capacity is maintained over a 12 month period despite a deterioration in basal fibrinolytic activity.