Effect of metformin on fibrinolysis in type 2 diabetes mellitus: an explorative study
AbstractType 2 diabetes mellitus (T2DM) is associated with a high incidence of vascular disease which can cause significant morbidity and mortality. The risk of cardiovascular mortality in T2DM patients is observed to be more compared to the age-matched subjects. This is attributed to depression of the fibrinolytic system which maintains patency of blood vessels. Endogenous inhibitors such as plasminogen activator inhibitor-1 (PAI-1) inhibit the activation of plasminogen and thus prevent the degradation of fibrinogen. In T2DM there is increased levels of PAI-1. Such a state of altered fibrinolysis is attributed to insulin resistance. A previous study done at our institute demonstrated higher euglobulin lysis time (ELT) in T2DM patients than controls, suggesting altered fibrinolytic activity in the former group. D-dimer is a degradation product of fibrin. Its presence indicates a state of hypercoagulability. In a study by Nwose et al rise in D-dimer levels were observed in diabetics, especially with cardiovascular complications as compared to controls indicating D-dimer could be a useful marker for predicting the complications in T2DM.
Carr ME. Diabetes Mellitus: a hypercoagulable state. J Diabetes Complications. 2001;15(1):44-54.
Yudkin JS. Abnormalities of coagulation and fibrinolysis in insulin resistance. Evidence for a common antecedent? Diabetes Care. 1999;22(3):25-30.
Nwose EU, Richards RS, Jelinek HF, Kerr PG. D-Dimer identifies stages in the progression of diabetes mellitus from family history of diabetes to cardiovascular complications. Pathology. 2007;39(2):252-7.
Gin H, Roudaut MF, Vergnot V, Baillet L, Rigalleau V. Effect of metformin on fibrinolytic parameters in insulin-treated, type 2 diabetic patients. Diabetes Metab. 2003;29(5):505-8
Alere Triage MeterPro System User Manual. Available at: http://www.appn.net.au/data/sites/ 1/appn/02implementation/technicalresources/d-dimer /aleretriagemeterprod-dimermethodandsample collection.pdf. Accessed on 10 January 2016.