Fibrinogen and factor VII levels improve with glycemic control in patientswith type 1 diabetes mellitus who have microvascular complications

To determine whether the hypercoagulable state of patients with complicatio ns of diabetes can be reversed toward normal, a group of insulin-dependent individuals with proteinuria was treated with intensive insulin protocols. A statistically significant (P<.001) improvement in control of diabetes was achieved (mean+/-SEM glycosylated hemoglobin, 9.51%+/-0.35% at baseline to 8.36%+/-0.39% at 12 months; and mean+/-SEM advanced glycosylated end produ cts, 14.8+/-2.8 U/mL at baseline to 8.4+/-1.5 U/mL at 12 months). There wer e statistically significant decreases in 2 procoagulant factors: mean+/-SEM baseline elevated plasma factor VII, 128.69%+/-5.63% at baseline to 106.24 %+/-3.43% at 12 months (P = .002); and mean+/-SEM plasma fibrinogen, 12.3+/ -0.7 <mu>mol/L (417.3+/-24.7 mg/dL) at baseline to 10.2+/-0.7 mu mol/L (348 .8+/-22.6 mg/dL) at 12 months (P = .04). Throughout the study, lipid fracti ons did not change significantly. Because plasma factor VII and fibrinogen concentrations were elevated while cholesterol and triglyceride concentrati ons were not, more attention should be paid to procoagulants as markers for thromboembolic complications in diabetic patients undergoing intensive ins ulin therapy.