Relationship between plasma soluble thrombomodulin levels and insulin resistance syndrome in type 2 diabetes: a comparison with von Willebrand factor

Endothelial dysfunction plays a pivotal role in the initial stage of athero sclerosis. Insulin resistance is associated with accelerated atherosclerosi s. especially coronary heart disease. To elucidate the relationship between endothelial dysfunction and insulin resistance or insulin resistance syndr ome in patients with type 2 diabetes. we investigated the correlation betwe en plasma soluble thrombomodulin (TM) and von Willebrand factor (vWF). meas ures of endothelial dysfunction, and the degree of insulin resistance evalu ated hv homeostasis assessment models of insulin resistance (HOMA-IR), or v ariables of insulin resistance syndrome. We studied 53 patients with type 2 diabetes, 23 treated with diet alone and 30 treated with sulfonylureas. wh o had normal renal function. The plasma soluble TM concentrations were high ly correlated with HOMA-IR (r = 0.64. p < 0.0001), the plasma insulin (r = 0.72. p < 0.0001). the systolic blood pressure (r = 0.45. p = 0.0005). and the plasma fibrinogen (r = 0.43. p = 0.0018), while they were inversely cor related with the serum HDL cholesterol concentrations (r = -0.27, p = 0.034 4). The plasma vWF concentrations were positively correlated with HOMA-IR ( r = 0.35, p = 0.0151) and the plasma fibrinogen (r = 0.32, p = 0.0203), but not with the plasma insulin, the systolic blood pressure or the HDL choles terol concentrations. Furthermore. plasma TM. but not vWF, was positively c orrelated with total number of variables of insulin resistance syndrome (r = 0.45. p = 0.0005). These results indicate that endothelial dysfunction ma y be associated with the pathogenesis of insulin resistance syndrome as wel l as insulin resistance, and that the plasma TM might reflect endothelial d amage better than the plasma vWF in the state: of insulin resistance in pat ients with type 2 diabetes.