Glycated Haemogloin, Fasting Plasma Glucose, Plasminogen Activator Inhibitor Type-1, and Soluble Thrombomodulin Levels in Patients with Type 2 Diabetes Mellitus

Abstract

Diabetes mellitus has become increasingly prevalent over the years. The chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunctions, and failure of different organs suggesting that the most effective tool to prevent complications is the effective control of hyperglycaemia itself. The study is set to determine the effect of glycemic control on plasminogen activator inhibitor type 1 (PAI-1), soluble thrombomodulin (STM) alongside fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) among type 2 diabetic subjects. One hundred diabetic subjects accessing care at the University of Calabar Teaching Hospital Calabar and 100 non –diabetics that served as controls were enrolled. Blood samples from participants were analyzed for FPG, HbA1c, PAI-1 and STM by standard methods. The result shows 74% of the diabetic to be females. Half of the diabetics were managed on only oral anti-diabetic drugs while the remaining half were either on insulin injection or a combination of oral and insulin injection.  Poor glycemic control was observed in 56% of the studied subjects. The mean age of 54.69 ± 9.94 years for the diabetics was comparable to the age-matched controls (p=.097). Diabetics showed significantly higher FPG, HbA1c, PAI-1and STM (P=0.001) compared to control values. Correlations between STM, PAI 1 and glycated hemoglobin (figures 2 p=0.001, p =0.001) and STM, PAI-1 and FPG revealed significantly robust association (p=0.001, p=0.001).  The study concludes that there is poor glycemic control among the treated diabetic subjects with PAI-1 and STM showing a very strong positive correlation with HbA1c than FPG.

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References

Agardh, A., Allebeck, P., Hallqvist, J., Moradi, T. & Sidorchuk, A. (2011). Type 2 diabetes incidence and socio-economic position: A systematic review and meta-analysis. International Journal of Epidemiology. 40: 804-818.

Akwiwu E.C., Edem M.S., Akpotuzor J.O., Isong I.K., Okafor A.O. & Okhhormhe Z.A. (2020). Glycemic control and associated platelet indices among apparently healthy caregivers in Southern Nigeria. New Zealand Journal of Medical Laboratory Science; 74: 87-90.

American diabetes Association (2018). Diabetes: New recommendations challenge decades-old guidelines. Healthline.

Berra-Romani, R., Guzmán-Silva, A., Vargaz-Guadarrama, A., Flores-Alonso, J. C., Alonso-Romero, J., Treviño, S., Sánchez-Gómez, J., Coyotl-Santiago, N., García-Carrasco, M. & Moccia, F. (2020). Type 2 Diabetes Alters Intracellular Ca2+ Handling in Native Endothelium of Excised Rat Aorta. International Journal of Molecular Sciences, 21: 250.

Brakemier, S., Eichler, J., Knorr, A., Fassheber, T., Kohler, R. & Hoyer, J. (2016). Modulation of Ca^(2+) activated K^+ channel in renal artery endothelium in situ by nitric oxide and reactive oxygen species. Kidney International, 64: 199-207.

Bretón‐Romero, R. Weisbrod, R. M., Feng, B., Holbrook, M., Ko D., Stathos, M. M., Zhang, J., Fetterman, J. L. & Hamburg, N. M. (2018). Liraglutide treatment reduces endothelial endoplasmic reticulum stress and insulin resistance in patients with diabetes mellitus. Journal of American Heart Association, 7: e009379.

Carrizzo, A., Izzo, C., Oliveti, M., Alfano, A., Virtuoso, N., Capunzo, Di Pietro, P., Calabrese, M., De Simone, E., Sciaretta, S., Frati, G., Migliarino, S., Damato, A., Ambrosio, M., De Caro, F. & Vecchione, C. (2018). The main determinants of diabetes mellitus vascular complications: Endothelial dysfunction and platelet hyperaggregation. International Journal of Molecular Science, 19: 2968.

Centers for Disease Control and Prevention (2014). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. Atlanta: U.S. Department of Health and Human Services.

Christensen, D. L.; Eis, J.; Hansen, A.W.; Larsson, M. W.; Mwaniki, D. L. & Kilonzo, B. (2008). Obesity and regional fat distribution in Kenyan populations: Impact of ethnicity and urbanization. Annals of Human Biology, 35: 232-249.

Chudy, P, Kotuhëová, D, Stäsko, J & Kubisz, P. (2011). The relationship among TAFI, t-PA, PAI-1 and F1+2 in type 2 diabetic patients with normoalbuminuria and microalbuminuria. Blood, 22: 493-98.

Dietrich S, Falk, CS, Benner, A, Karamustafa, S, Hahn, A. & Andrulis, M. (2013). Endothelial vulnerability and endothelial damage are associated with risk of graft-versus-host disease and response to steroid treatment. Biology, Blood Marrow Transplant, 19: 22-27.

Dogné, S., Flamion, B. & Caron, N. (2018). Endothelial glycocalyx as a shield against diabetic vascular complications: Involvement of Hyaluronan and Hyaluronidases. Arteriosclerosis, Thrombosis and Vascular Biology, 38: 1427–1439.

Elsalakawy, W. A., Farweez, B. A., Sallam, M. T. & Hamza, M. A. (2014). High levels of soluble thrombomodulin maybe a marker of arterial disease and peripheral ischemia in Egyptian patients with diabetes mellitus. Egyptian Journal of Haematology, 39: 52-57.

Favero, G., Paganelli, C., Buffoli, B., Rodella, L. F. & Rezzani, R. (2014). Endothelium and Its Alterations in Cardiovascular Diseases: Life Style Intervention. Biomedical Research International, 801896.

Hayden, M. R. (2019). Type 2 Diabetes Mellitus Increases the Risk of Late-Onset Alzheimer’s Disease: Ultrastructural Remodeling of the Neurovascular Unit and Diabetic Gliopathy. Brain Science, 9: 262.

Hilawe, E. H., Yatsuya, H., Kawaguchi, L. & Aoyama, A. (2013). Differences by sex in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub- Saharan Africa: A systematic review and meta-analysis. Bulletin of the World Health Organization, 91: 671-682D.

Iantorno, M., Campia, U., Di Daniele, N., Nistico, S., Forieco, G. B., Cardilo, C. & Tesauro, M. (2014). Obesity, inflammation and endothelial dysfunction. Journal of Biological Regulators and Homeostatic Agents, 28: 169-176.

Ikezoe Takayuki (2015). Thrombomodulin/ activated protein C system in septic disseminated intravascular coagulation. Journal of Intensive Care, 3(1):1.

International Diabetes Foundation (2017). IDF diabetes atlas. 7th edition. http://www.diabetes.atlas.org.

Kahn, S. E., Cooper, M. E. & del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet, 383:1068–1083.

Kavanagh, A.; Bently, R. J., Turrell, G., Shaw, J., Dunstan, D. & Subramanian, S. V. (2010). Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. Social Science Medicine, 71: 1150-1160.

Kubisz, P., Chudý, P., Stäsko, J., Galajda, P., Holly, P., Vysehradský, R. & Mokáň, M. (2010). Circulating vascular endothelial growth factor in the normo- sand / or microalbuminuric patients with type 2 diabetes mellitus. Acta Diabetologica, 47: 119-124.

Lau, Y. S., Ling, W. C., Murugan, D. & Mustafa, M. R. (2015). Boldine Ameliorates Vascular Oxidative Stress and Endothelial Dysfunction: Therapeutic Implication for Hypertension and Diabetes. Journal of Cardiovascular Pharmacology, 65: 522–531.

Page, A. V. & Conrad, L. W. (2013). Biomarkers of endothelial activation/ dysfunction in infectious diseases. Virulence, 4: 507-516.

Pernow, J., Kiss, A., Tratsiakovich, Y. & Climent, B. (2015). Tissue-specific up-regulation of arginase I and II induced by p38 MAPK mediates endothelial dysfunction in type 1 diabetes mellitus. British Journal of Pharmacology, 172: 4684–4698.

Rosenson, R. S., Fioretto, P., Dodson, P. M. (2011). Does microvascular disease predict macrovascular event in type 2 diabetes. Atherosclerosis, 218: 13-18.

Sabir, A. A., Balarabe, S., Sani, A. A., Isezuo, S. A., Bello, K. S., Jimoh, A. O. & Iwuala, S. O. (2017). Prevalence of diabetes mellitus and its risk factors among the sub-urban population of northwest Nigeria. Sahel Medical Journal, 20: 168-172.

Schiattarella, G. G., Carrizzo, A., Ilardi, F., Damato, A., Ambrosio, M., Madonna, M., Trimarco, V., Marino, M., De Angelis, E., Settembrini, S., Perrino, C., Trimarco, B., Esposito, G. & Vecchione, C. (2018). Rac1 Modulates Endothelial Function and Platelet aggregation in diabetes mellitus. Journal of American Heart Association, 7: e007322.

World Health Organization (2011). WHO Report of a World Health Organization consultation. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Diabetes Research in Clinical Practice, 93: 299–309.

World Health Organization (2019). Classification of diabetes. Geneva: World Health Organization.

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