Glycemic control and coagulation inhibitors in diabetic patients

Objective: To investigate the plasma antigenic levels and functional activi ties of coagulation inhibitors in poorly controlled diabetic patients and t he possible effect of good glycemic control on these parameters. Research D esign and Methods: Both functional activities and plasma antigenic levels o f coagulation inhibitors (antithrombin III, heparin cofactor II, protein C, and protein S) and plasma levels of C4b-binding protein were measured in 2 8 diabetic patients (13 males, 15 females; 2 IDDM, 26 NIDDM; median age 56. 5 years; median duration of diabetes 5.5 years) with poor glycemic control (median HbA(1c) 11.8%). Twenty-three healthy subjects were enrolled as cont rols. Following a 3-month intensification of antihyperglycemic therapy, goo d glycemic control (HbA(1c) <8%) was achieved in 17 patients, and the plasm a levels of the same parameters during this period were compared with basel ine values. Results: Functional activities and plasma antigenic levels of c oagulation inhibitors were comparable in poorly controlled diabetic patient s and healthy subjects. In patients achieving good control after 3 months, there was a significant reduction in plasma antigenic levels of protein S ( p = 0.005) and C4b-binding protein (p = 0.03); however, no difference could be observed in other parameters. HbA(1c) did not show any correlation with plasma antigenic levels or functional activities of coagulation inhibitors either at baseline or at 3 months of good glycemic control. Conclusions: O ur findings suggest that in poorly controlled diabetic patients, coagulatio n inhibitors are not different from healthy controls. Short-term good glyce mic control may not exert a profound effect on coagulation inhibitors excep t protein S and its binding protein, C4b-binding protein.