GLYCOMETABOLIC CONTROL, LIPIDS, AND COAGULATION PARAMETERS IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Diabetes mellitus and hyperlipidemia are associated with coronary hear t disease and with hypercoagulability, another independent risk factor for coronary heart disease. In 65 non-insulin-dependent diabetes mell itus patients [41 females, 24 males, median age 66 years (range 43 - 8 1 years)] treated with antidiabetic agents glycometabolic control (HbA 1c), lipids (Quetelet index and blood lipids), and several coagulation parameters were studied in comparison with a reference group. Serum t riglycerides were elevated [median (interquartile range) 2.3 (1.3) mmo l/l vs. 1.6 (0.7) mmol/l in the controls (P < 0.001)], whereas the med ian lipoprotein(a) concentration was 65 (157) mg/l in the diabetic pat ients versus 44 (114) mg/l in the control group (not significantly dif ferent). Median high-density lipoprotein-cholesterol concentrations we re slightly decreased in the diabetic patients: 1.2 (0.3) mmol/l compa red with 1.3 (0.4) mmol/I in the control group (P < 0.02). Elevated le vels of fibrinogen, fibrin monomers, thrombin-antithrombin III complex , and factor VIIIc were found in the diabetic patients and factor VII in male diabetic patients. These elevated coagulation parameters are i ndicators of an activated coagulation system in this patient group. By Spearman's rank test, only HbA1c values correlated with antithrombin III (r = 0.27, P < 0.03) and showed a tendency towards a correlation w ith lipoprotein(a) (r = 0.23, P < 0.07). Triglycerides correlated with the Quetelet index (r = 0.27, P < 0.03), high-density lipoprotein-cho lesterol (r = -0.41, P < 0.001), and factor VII (r = 0.35, P < 0.01), whereas serum cholesterol concentrations correlated with factor VII (r = 0.27, P < 0.04) and with fibrin monomers (r = 0.29, P < 0.03). In t his group of 65 non-insulin-dependent diabetes mellitus patients we fo und a characteristic adverse lipid profile in association with signs o f an activated coagulation system. Glycometabolic control appeared to have no major influence on the degree of activation of the coagulation system in these patients. This study supports the more aggressive app roach advised in the treatment of hyperlipidemia in diabetic patients.