Effects of mealtime insulin aspart and bedtime neutral protamine Hagedorn insulin on postprandial coagulation and fibrinolysis in patients with type 2 diabetes

• Published in: Diabetes, obesity & metabolism Vol. 14; no. 5; pp. 447 - 453
• Main Authors: Bladbjerg, E. M., Henriksen, J. E., Akram, S., Gram, J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2012; Wiley Subscription Services, Inc
• Subjects: Biomarkers - blood; Blood Coagulation - drug effects; Coagulation; Coagulation factors; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Female; Fibrinolysis; Fibrinolysis - drug effects; Glucose; Humans; hyperglycaemia; Hyperglycemia; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - pharmacology; Insulin; Insulin Aspart - administration & dosage; Insulin Aspart - pharmacology; insulin treatment; Insulin, Isophane - administration & dosage; Insulin, Isophane - pharmacology; Male; Middle Aged; Plasminogen activator inhibitors; Postprandial Period; Protamine; Protamine sulfate; Prothrombin; t-Plasminogen activator; type 2 diabetes
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/j.1463-1326.2011.01547.x

Aim: Acute hyperglycaemia induces coagulation activation in diabetes patients. We hypothesized that rapid‐acting insulin has a beneficial postprandial effect on coagulation and fibrinolysis compared with intermediate‐acting insulin because of its ability to lower postprandial hyperglycaemia. Methods: This was tested in a parallel controlled study in well‐controlled patients with type 2 diabetes assigned to bedtime neutral protamine Hagedorn (NPH) insulin (n = 41) or mealtime insulin aspart (n = 37). They were served standard diabetic meals for breakfast (8:00 hours) and lunch (12:00 hours). Blood samples were collected at 7:40 hours (fasting), 9:30, 11:30, 13:30 and 15:30 hours and analysed for glucose, activated factor VII (FVIIa), D‐dimer, prothrombin fragment 1+2 (F1+2), tissue plasminogen activator antigen (t‐PA) and plasminogen activator inhibitor activity (PAI). Results: The postprandial glucose response differed significantly between insulin regimens with a postprandial increase on NPH insulin and a decrease on insulin aspart. There was a significant postprandial decrease in F1+2, PAI and t‐PA, and no changes in FVIIa and D‐dimer, on both insulin regimens, but with no differences between insulin treatment groups. Conclusions: The rapid‐acting insulin analogue aspart and the intermediate‐acting insulin NPH had similar postprandial effects on markers of coagulation activation and fibrinolysis despite different effects on postprandial glucose response.