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Fibrinogen and Factor VII Levels Improve With Glycemic Control in Patients With Type 1 Diabetes Mellitus Who Have Microvascular Complications
John A. D'Elia, MD;
Larry A. Weinrauch, MD;
Ray E. Gleason, PhD;
Izabela Lipinska, PhD;
Joanne Keough, RN;
Shona Pendse, MD;
Bijan Roshan, MD;
Annette T. Lee, PhD;
Geoffrey H. Tofler, MD
Arch Intern Med. 2001;161:98-101.
To determine whether the hypercoagulable state of patients with complications
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 products, 14.8 ± 2.8 U/mL at baseline
to 8.4 ± 1.5 U/mL at 12 months). There were 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 µmol/L (417.3 ± 24.7 mg/dL) at
baseline to 10.2 ± 0.7 µmol/L (348.8 ± 22.6 mg/dL) at
12 months (P = .04). Throughout the study, lipid
fractions did not change significantly. Because plasma factor VII and fibrinogen
concentrations were elevated while cholesterol and triglyceride concentrations
were not, more attention should be paid to procoagulants as markers for thromboembolic
complications in diabetic patients undergoing intensive insulin therapy.
From the John Cook Renal Unit, Joslin Diabetes Center, Boston, Mass
(Drs D'Elia, Weinrauch, and Roshan and Ms Keough); the Clinical Research Section,
Mount Auburn Hospital, Cambridge, Mass (Dr Weinrauch); the Institute for Prevention
of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston (Drs
Lipinska and Tofler); the Biostatistical Section, Endocrine-Hypertension Unit,
Brigham and Women's Hospital, Boston (Dr Gleason); the Picower Institute for
Medical Research, Manhasset, NY (Dr Lee); and the Harvard Medical School,
Boston (Drs D'Elia, Weinrauch, Gleason, Lipinska, Pendse, Roshan, and Tofler).
Reprints: John A. D'Elia, MD, 1 Joslin Pl, Boston, MA 02215.
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