Comparison of Glycosylated Fibrinogen, Albumin, and Haemoglobin as Indices of Blood Glucose Control in Diabetic Patients

Abstract

The value of glycosylated fibrinogen as an index of short-term diabetic control was compared with indices of long-term (glycosylated haemoglobin) and intermediate-term (glycosylated albumin) diabetic control, respectively. In this study, percentages of these glycosylated proteins and fasting plasma glucose concentration were determined in 95 healthy non-diabetic subjects and 48 diabetic patients (22 well-controlled and 26 poorly-controlled) after an overnight fast. The differences in the percentages of glycosylated fibrinogen, haemoglobin, and albumin between non-diabetic subjects (4.7, 6.4, and 2.0), well-controlled diabetic patients (6.9, 9.5 and 2.9), and poorly-controlled diabetic patients (11.3, 15.8, and 5.1) were statistically significant (p less than 0.05). The percent glycosylated fibrinogen exhibited significant association with severity of hyperglycaemia when diabetic patients were divided by 2, 4, and 6 standard deviations above the mean of fasting plasma glucose of non-diabetic subjects. There were significant correlations between glycosylated fibrinogen and fasting plasma glucose (r = 0.83, p less than 0.001), glycosylated haemoglobin (r = 0.94, p less than 0.001) and glycosylated albumin (r = 0.92, p less than 0.001) for all subjects studied. In ten newly diagnosed diabetic patients after 6 days of treatment, only the decrease in glycosylated fibrinogen (33.4%) was significant (p less than 0.05), but not that of glycosylated haemoglobin (4.8%) or albumin (8.0%). It is suggested that glycosylated fibrinogen provides the clinician with earlier objective evidence of the metabolic response to therapeutic intervention, and might be regarded as a short-term (2-3 days) index of blood glucose control.

High-Dose Aspirin Is Required to Influence Plasma Fibrin Network Structure in Patients With Type 1 Diabetes

“…One plausible explanation behind the observed dose-dependent effect of aspirin on fibrin network permeability in diabetes is increased glycation of fibrinogen molecules in plasma (13,14). It has been suggested that glycated fibrinogen may have reduced susceptibility to acetylation by aspirin, and competition between glycation and acetylation of fibrinogen amino groups has been observed in vitro (23).…”

“…In previous studies, we have shown that patients with type 1 diabetes have reduced fibrin network permeability and that improved metabolic control is associated with increased fibrin network permeability (11,12). The altered fibrin network in patients with type 1 diabetes may in part be attributed to increased fibrinogen glycation, as shown in studies on fibrinogen purified from diabetic patients (13,14). Treatment with aspirin increases fibrin network permeability in nondiabetic subjects, possibly through acetylation of lysine residues on plasma fibrinogen (15–17).…”

Glycation of fibrinogen in uncontrolled diabetic patients and the effects of glycaemic control on fibrinogen glycation

“…Glycated fibrinogen has been suggested as a predictor of glycaemic control [28], [29], [30] and [35]. Due to its short half life, glycated fibrinogen is an ideal marker for monitoring short term glycaemic control and therefore the early assessment of the effectiveness of a treatment regime or a research study with a short duration.…”

“…openUP Fibrinogen has been shown to be an independent risk marker for CVD [11]. Fibrinogen may contribute significantly to the increased CVD risk in patients with diabetes both in that they generally have elevated fibrinogen levels and that fibrinogen undergoes nonenzymatic glycation in the presence of uncontrolled blood glucose levels in the diabetic subject [12], [13], [14] and [15]. This glycation can alter fibrinogen structure/function, which may then result in the formation of a tight and rigid fibrin network that is resistant to lysis [16], [17] and [18].…”

Hypofibrinolysis in diabetes: a therapeutic target for the reduction of cardiovascular risk

“…Fibrinogen glycation in subjects with diabetes is modulated by improving glycaemic control [76, 78, 82]. Pieters et al observed that improving glycaemia had no effect on the structure of fibrin clots made from T2DM plasma although an effect on clots made from purified fibrinogen was observed [80, 83].…”