Prothrombin time, activated partial thromboplastin time and platelet counts of type II diabetes mellitus: a comparative study

Quality of glycemic control in type 2 diabetes mellitus (T2DM) and its association with markers of coagulation and inhibitors of fibrinolysis: A case-control study in the Upper West Region, Ghana

Background and Aims

Type 2 diabetes mellitus (T2DM) individuals are at a higher risk of developing diabetes complications, with approximately 80% complication-related mortality. The increased morbidity and mortality among T2DM patients are partly due to dysregulated hemostasis. This study determined the quality of glycemic control in T2DM and its association with markers of coagulation and inhibitors of fibrinolysis.

Methods

This case-control study recruited 90 participants involving: 30 T2DM patients with good glycemic control, 30 with poor glycemic control, and 30 nondiabetic subjects as controls at a Municipal Hospital in Ghana. Fasting blood glucose, glycated hemoglobin, activated partial thromboplastin time (APTT), prothrombin time (PT), calculated international normalized ratio (INR), and full blood count (FBC) were determined for each respondent. Plasma levels of plasminogen activator inhibitor-1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI) were determined using the solid-phase sandwich enzyme-linked immunosorbent assay method. Data were analyzed using R language software.

Results

Plasma PAI-1 antigen levels were significantly higher in the participants with poor glycemic control as compared to participants with good glycemic control (p < 0.0001). There was no significant difference in plasma TAFI levels between the participants with poor glycemic control as compared to participants with good glycemic control (p = 0.900). T2DM patients had significantly shorter APTT, PT, and INR than controls (p < 0.05). At a cut-off of ≥161.70 pg/μL, PAI was independently associated with increasing odds (adjusted odds ratio = 13.71, 95% confidence interval: 3.67-51.26, p < 0.0001) of poor glycemic control and showed the best diagnostic accuracy for poor glycemic control (area under the curve = 0.85, p < 0.0001).

Conclusion

PAI-1 levels were significantly increased in T2DM with poor glycemic control and emerged as the best predictor for poor glycemic control. Good glycemic management to control the plasma levels of PAI-1 is required to prevent hypercoagulability and thrombotic disorders.

The Prevalence of Coagulopathy and Associated Factors Among Adult Type II Diabetes Mellitus Patients Attending the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

INTRODUCTION

Diabetes mellitus is a heterogeneous disorder of metabolism which results hyperglycemic-related atherothrombotic complications. These complications are the leading cause of death in diabetes mellitus patients. Therefore, this study was aimed to determine the prevalence of coagulopathy and associated factors among adult type II diabetes mellitus patients attending at University of Gondar comprehensive specialized hospital.

METHODS

A facility-based cross-sectional study was conducted among 357 study participants. A questionnaire and a data collection sheet were used to collect the sociodemographic and clinical data, respectively. About 6mL of venous blood samples were collected for coagulation tests and complete blood count. For prolonged coagulation tests, a mixing test was performed. Data were entered into EpiInfo and exported to SPSS for statistical analysis. Then, descriptive statistics were done. A binary and multivariable logistic regression model was used to identify the associated factors. P-value <0.05 was considered as statistically significant.

RESULTS

In this study, 357 study participants were included. Of them, 52.1% (186) and 80.7% (288) were females and urban residences, respectively. The prevalence of coagulopathy was 26.6% (95% CI: 22.1, 31.5%). Out of this, 12.3% and 8.7% showed shortened PT and aPTT, respectively. In addition, the prevalence of prolonged PT and aPTT were 5.6% and 3.9%, respectively. From the prolonged PT and aPTT, the prevalence of factor deficiency was 95% and 92.8%, respectively. Being female (AOR = 2.06; 95% CI: 1.11-3.85%), abnormal BMI (AOR = 1.94; 95% CI: 1.08-3.50), and educational status of high school (AOR = 0.26; 95% CI: 0.10-0.83%) were significantly associated with hypercoagulation.

CONCLUSION

Coagulopathy is an important public health problem among type II diabetes mellitus patients. Being female and having abnormal BMI were associated with hypercoagulation. Therefore, regular monitoring of coagulation parameters is vital to reduce the consequence of coagulopathy.

Treatment modality, diabetic control and blood homeostasis in type 2 diabetes mellitus patients in Basra

This study is aimed at investigating the relationship between treatment modality, glycemic control and blood homeostasis as represented by prothrombin time (PT) and activated thromboplastin time (APTT) in T2DM patients. Sixty-four type 2 diabetic patients (40 males and 24 females) on metformin or insulin or both for not less than six months of ages between 20 and 75 years were selected during their visit to Diabetes Endocrine and Metabolism Centers in two General Hospitals in Basra. Socioeconomic characteristics and treatment plans were recorded. Glycated haemoglobin (HbA1c), lipid profiles and hematological parameters measured in blood samples were taken. Lower mean HbA1c (p = 0.0383) was found in patients on metformin alone, higher percentage of hemoglobin was found in patients on insulin treatment, and higher levels of LDL (P = 0.0018) and HDL (P = 0.0241) in patients on metformin and insulin. Treatment manner had no effect on mean PT or APTT, however, there was a significant inverse correlation of PT with LDL (P = 0.0042), and a direct correlation of APTT with HbA1c (p = 0.0209) and an inverse correlation of APTT with platelets count (P = 0.0324) in patients on insulin treatment. In addition, there was a significant direct correlation of APTT with triglycerides (TG) (P = 0.0069) in patients on metformin treatment. In conclusion, lower mean of HbA1c was found only in patients receiving metformin drug alone, higher Hb percentage were found in patients treated with insulin alone, higher LDL and higher HDL levels were found in patients treated with both metformin and insulin for at least six months. Treatment manner had no effect on mean PT or APTT and further studies are needed to bring about understanding of diabetic control and blood homeostasis.