ACTIVATION OF COAGULATION IN DIABETES-MELLITUS IN RELATION TO THE PRESENCE OF VASCULAR COMPLICATIONS

To examine the relationship between diabetic vascular disease and haemostasis, a set of sensitive assays has been used to assess in vivo activation of coagulation in 62 diabetic patients (41 Type 1 and 21 Type 2), aged 19-68 years, who had been screened for the presence of complications. Fibrinopeptide A, an index of thrombin activity, was significantly increased in diabetic patients compared with control subjects (p < 0.05), in both plasma (with complications mean 8.04 +/- 11.87 (+/- SD); without complications 7.21 +/- 10.13; control subjects 2.11 +/- 1.40-mu-g l-1) and urine (with complications mean 1.48 +/- 0.74; without complications 1.35 +/- 0.62; control subjects 0.98 +/- 0.39-mu-g l-1). Activated factor VII (VIIa ratio 1.21 +/- 0.39; 1.13 +/- 0.23; 1.01 +/- 0.11) and fibrinogen (3.15 +/- 0.59; 3.11 +/- 0.69; 2.70 +/- 0.57 g l-1) were also elevated in diabetic patients with and without complications (VIIa p < 0.05, fibrinogen p < 0.01). The only difference between Type 1 and Type 2 patients was in fibrin degradation products (Type 1 0.28 +/- 0.18; Type 2 0.40 +/- 0.18 mg l-1, p < 0.01). Plasma levels of fibrin degradation products were elevated in diabetic patients (p < 0.05 vs control subjects), and correlated with age (r = 0.44, p < 0.01) but were unrelated to the presence of complications. There were no significant differences in any coagulation variables between diabetic patients with and without complications. HbA1 was correlated with fibrin degradation products only (r = 0.30, p < 0.05), and there were no correlations with current blood glucose concentration. Our results show activation of the coagulation system in diabetes which precedes the appearance of clinically detectable complications and suggests early vascular damage.