The fibrinolytic response to exercise at diagnosis and after 12 months in patients with type 2 diabetes mellitus
Gough SCL., McCormack L., Rice PJS., Grant PJ.
Objective: To determine fibrinolytic activity and exercise stimulated fibrinolytic capacity in patients with type 2 diabetes mellitus at diagnosis and after 12 months treatment aimed at improving glycaemic control. Subjects: Thirteen patients referred to the hospital diabetic out-patient department with a new diagnosis of type 2 diabetes mellitus were selected for study. Methods: Basal fibrinolytic activity and exercise stimulated fibrinolytic capacity were measured at diagnosis and after 12 months of interventional therapy. Results: Compared with controls basal fibrinolytic activity was depressed in the diabetic patients due to increased levels of PAI-1:Ag 15.1(4.6-20) versus 8.4 (3.0-9.9) ng/ml, p<0.05 and PAI,17.6 (10.9-26.8) versus 6.6 (4.8-13.6) IU/ml, p<0.01. PAI was related to fasting plasma insulin levels r=0.8, p<0.001 and body mass index r=0.7, p<0.01 at diagnosis, but not triglycerides or blood pressure. Median t-PA:Ag was also elevated in the diabetic group 9.8 (6.3-12.1) versus 4.5 (3.1-7.1) ng/ml, p<0.001. The percentage change in ECLT with exercise was inversely proportional to the degree of insulin resistance r=-0.08, p<0.001 and fasting plasma insulin r=-0.65, p--0.02, at diagnosis. Despite an improvement in glycosylated haemoglobin, 8.7 (1.8) to 7.0 (1.2) %, p=0.008, over 12 months, the ECLT increased from 290 (220-315) to 360 (316-375) mins, p<0.05. This was associated with an increase in the PAI-1:Ag/t-PA:Ag ratio from 1.92 (1.63) to 2.48 (0.97), p=0.025. Although t-PA release due to exercise was reduced in the diabetic group (38%) compared to non-diabetic controls (82%) p<0.001, similar results were found after 12 months 54.5% to those at diagnosis 38%, (NS). Conclusion: This study has shown that in a selective group of type 2 diabetic patients, exercise stimulated fibrinolytic capacity is maintained over a 12 month period despite a deterioration in basal fibrinolytic activity. © 1994.