Study of plasma fibrinogen level and its relation to glycemic control in type-2 diabetes mellitus patients attending diabetes clinic at a tertiary care teaching hospital in Madhya Pradesh, India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20162613Keywords:
Type 2 diabetes mellitus, Fibrinogen, Glycemic control, Lipid parameters, Cardiovascular risk factorsAbstract
Background: Diabetes mellitus comprises a group of common metabolic disorders where increased fibrinogen levels can act as a thrombogenic factor. Diabetic patients have higher cardiovascular morbidity than non-diabetic subjects. Several studies have shown that haemostatic factor especially hyperfibrinogenemia is implicated as a source of atherosclerosis and its complications.
Methods: A comparative observational study was conducted to compare fibrinogen levels between type 2 diabetes patients and healthy controls. Their fibrinogen levels were compared and co-related with glycemic status and other risk factors and parameters like glycosylated haemoglobin, age, sex, smoking, body mass index (kg/m2), hypertension and ischemic heart disease.
Results: It was seen that in the diabetic subset, the plasma fibrinogen levels are significantly higher than the non-diabetic subset (386.04±132.87 vs. 314.38±97.42; p<0.001). Our study re-established correlation between HbA1c and fibrinogen levels of the diabetic patient is positive i.e., poorer the glycemic status, higher the fibrinogen levels (r=0.24).
Conclusions: It can be concluded from the study that fibrinogen levels are increased in type 2 diabetic subjects with and without CHD. Plasma fibrinogen levels usually increased in type 2 diabetes, thus suggesting that hyperfibrinogenemia could contribute to the excess cardiovascular morbidity and mortality in this disease.
References
Alvin CP. Diabetes Mellitus. In: Braunwald E, Faucei AS, Kasper DL, Hauser SL, Longo DL, Larry JJ (eds) Harrison’s principles of internal medicine. 15th ed. New York: McGraw Hill Medical Publishing division; 2001:2109-2137.
Bruno G, Cavallo-perin P, Bargero G, Borra M, Errico ND, Pagano G. Association of fibrinogen with glycemic control and albumin excretion rate in patients with non-Insulin-dependent diabetes mellitus. Ann Intern Med. 1996;125:653-7.
Fuller JH, Keen H, Jarrett RJ, Omer T, Meade TW, Charkrabarti R. Haemostatic variables associated with diabetes and its complications. Br Med J. 1979;2:964-6.
Kannel BW, Wilson WF, Belanger AJ, Gagnon Dr, D’Agostino BD. Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience. JAMA. 1987;258:1183-6.
Anjula J, Gupta HL, Narayan S. Hyperfibrinogenemia in patients of diabetes mellitus in relation to glycemic control and urinary albumin excretion rate. JAPI. 2001;49:227-30,
Ernst E, Ludwig KR. Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of literature. Ann Intern Med. 1993;118:956-63.
Wilhelmsen L, Suardsudd K, Kristoffer KB, Larson B, Lennart W, Jibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med. 1984;311:501-5.
Thompson WD, Smith EB. Atherosclerosis and coagulation system. J Pathol. 1989;159:97-106.
Mittal S, Dwivedi RN, Lalchandani A, Puri A, Mishra P. Correlation of fibrinogen as an indicator of both long and short term glycemic control in diabetes. JAPI. 2002;50:129-30.
Biggs R, McFarlane R G. Human blood coagulation and its disorders. 3d ed. F.A. Davis Company, Philadelphia; 1962:474.
Quick AJ. Hemorrhagic diseases and thrombosis. 2nd ed. Philadelphia: Lea and Febiger; 1966:460.
Schmidt RM, Fairbanks VF, editors. Electrophoretic mobilities of mutant hemoglobins and mutant globin chains. In: Schmidt RM, Fairbanks VF, eds. CRC handbook series in clinical laboratory science, Section 1: Haematology, Volume III, Boca Raton, Florida, USA: CRC Pr I Llc; 1980:125-139.
Dacie J V, Lewis S M. Practical Haematology, 8th ed. Churchill Livingstone Publications; 1995:305.
Sachs DB. Carbohydrates. In: Burtis CA, Ashwood ER, editors. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia: W.B. Saunders Company; 1999:790-796.
Jeppsson JO, Kobold U, Barr J, Finke A, Hoelzel W, Hoshino T, et al. Approved IFFC reference method for the measurement of HbA1c in human blood. Clin Chem Lab Med. 2002;40:78-89.
American Diabetes Association. Standards of medical care in diabetes‑2011. Diabetes Care. 2011;34(Suppl 1):S11‑61.
Bembde AS. A study of plasma fibrinogen level in type-2 diabetes mellitus and its relation to glycemic control. Indian J Hematol Blood Transfus. 2012;28(2):105-8.
Brownlee M, Ulassara H, Cerami A. Nonenzymatic glycosylation reduces the susceptibility of fibrin to degradation by plasmin. Diabetes. 1983;32:680-4.
Pierpaola DF, Margaret GG, Haymond MW. Differential effects of insulin deficiency on albumin and fibrinogen synthesis in humans. J Clin Invest. 1991;88:833-40.
Stec JJ, Silbershatz H, Tofler GH, Matheney TH, Sutherland P, Lipinska I, et al. Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the framingham offspring population. Circulation. 2000;102:1634-8.
Haffner SM. The metabolic syndrome: inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol. 2006;97:3A-11.
Di Napoli M, Papa F, Bocola V. Prognostic influence of increased C-reactive protein and fibrinogen levels in ischaemic stroke. Stroke. 2001;32:133-8.
Letcher RL, Chien S, Pickering TG, Sealey JE, Laragh JH. Direct relationship between blood pressure and blood viscosity in normal and hypertensive subjects. Role of fibrinogen and concentration. Am J Med. 1981;70:1195-202.
Maresca G, Di Blasio A, Marchioli R, Di Minno G. Measuring plasma fibrinogen to predict stroke and MI: an update. Arterioscler Thromb Vasc Biol. 1999;19:1368-77.
Kannel WB, D'Agostino RB, Wilson PW, Belanger AJ, Gagnon DR. Diabetes, fibrinogen, and the risk of cardiovascular disease: the Framingham experience. Am Heart J. 1990;120(3):672-6.
Ganda OP, Arkin CF. Hyperfibrinogenemia. An important risk factor for vascular complications in diabetes. Diabetes Care. 1992;15:1245-50.
Missov RM, Stolk RP, van der Bom JG, Hofman A, Bots ML, Pols HA, et al. Plasma fibrinogen in NIDDM. The Rotterdam Study. Diabetes Care. 1996;19:157-9.
Garcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetes in the Framingham population: sixteen year follow-up study. Diabetes. 1974;23:105-11.
Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham Study. JAMA. 1979:241:2035-8.
