Effect of ?a-adrenoceptor antagonist on platelet activation during insulin-induced hypoglycaemia in Type 2 (non-insulin-dependent) diabetes mellitus

Dp, Mikhailidis; Ma, Bo; Jy, Jeremy; Dandona, Paresh

doi:10.1007/bf00505191

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Earlier reports showed that hypoglycemia was involved, directly or indirectly, in multiple steps of coagulation cascade and thrombosis, including platelet activation, 49 –52 aggregation, 53 –56 and secretion 45,47,50,51 (Figure 2). Insulin-induced hypoglycemia is accompanied by a significant enhancement of platelet aggregation, decreased platelet counts and activated partial thromboplastin time, and increased fibrinogen and factor VIII.…”

Section: Physiological and Pathophysiological Effects Of Hypoglycemia On The CV Systemmentioning

confidence: 98%

The Impact of Hypoglycemia on the Cardiovascular System

2016

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Intensive glycemic control may increase cardiovascular (CV) risk and mortality due to hypoglycemia. The pathophysiology of glucose counter-regulation in patients with type 1 or type 2 diabetes for over 15 years is characterized by impairment of the defense mechanisms against hypoglycemia. Hypoglycemia causes pronounced physiological and pathophysiological effects on the CV system as consequences of autonomic system activation and counter regulatory hormones release. These effects provoke a series of hemodynamic changes that include an increase in heart rate and peripheral systolic blood pressure, a decrease in central blood pressure, reduced peripheral arterial resistance, and increased myocardial contractility and cardiac output. Cardiac electrophysiological changes including flattening or inversion of T waves, QT prolongation, and ST segment depression were observed in both insulin-induced and spontaneous hypoglycemia. Sympathoadrenal activation is the main cause of these changes through mechanisms that involve, but are not limited to, catecholamine-mediated hypokalemia. Hypoglycemia is also involved in platelet activation. There is growing concern about the long-term effects of hypoglycemia, especially as related to inflammation and atherogenesis.

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Section: Physiological and Pathophysiological Effects Of Hypoglycemia On The CV Systemmentioning

confidence: 98%

The Impact of Hypoglycemia on the Cardiovascular System

2016

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“…Platelet function was enhanced with decreasing blood glucose, and increased platelet function was strongly correlated with an increase in epinephrine (STUDY2). Several studies have shown that plasma epinephrine may have an important role in platelet activation during hypoglycemia in patients with type 2 diabetes [34, 35]. Epinephrine is secreted from the adrenal medulla through the activation of the sympathetic nervous system as a physiological defence when PG levels fall [36].…”

Section: Discussionmentioning

confidence: 99%

Effects of glycemic control and hypoglycemia on Thrombus formation assessed using automated microchip flow chamber system: an exploratory observational study

et al. 2019

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Background Thrombus formation is an important factor affecting cardiovascular events and venous thromboembolism in type 2 diabetes. However, it is unclear whether glycemic control reduces thrombogenicity. We investigated the effect of short-term glycemic control (STUDY 1) and hypoglycemia (STUDY 2) on thrombus formation using an automated microchip flow chamber system. Methods For STUDY 1, we recruited 10 patients with type 2 diabetes. Before and after 2 weeks of treatment, blood glucose was analyzed with a continuous glucose monitoring system, and thrombogenicity was analyzed with an automated microchip flow chamber system. For STUDY 2, we recruited 10 subjects without diabetes who underwent an insulin tolerance test. We evaluated the change in thrombogenic potential with hypoglycemia. Results STUDY1: The mean blood glucose level reduced from 10.1 ± 2.6 to 6.9 ± 0.97 mM ( P < 0.01). T10, an indicator of thrombogenicity, significantly attenuated after glycemic control (338 ± 65 vs. 425 ± 117 s, P < 0.05). The attenuation in T10 was significantly correlated with changes in mean blood glucose level after treatment ( r = − 0.718, P < 0.05). STUDY 2: Platelet function was enhanced with decreasing blood glucose; increased platelet function was strongly correlated with an increase in epinephrine. Conclusions We demonstrated attenuation in thrombogenicity with short-term comprehensive diabetes care and enhancement in thrombogenicity with hypoglycemia, using a new flow chamber system. Trial registration UMIN-CTR UMIN 000019899 , registered 26-Jan-2015 (STUDY 2). Electronic supplementary material The online version of this article (10.1186/s12959-019-0206-8) contains supplementary material, which is available to authorized users.

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“…25 This emerging difference needs to be revisited. Given the importance of MPV as a marker of activated platelets 4 and as a predictor of vascular events, 4,6 including DM, 12,13,30 this effect of rosuvastatin and atorvastatin is encouraging. In contrast, it is worth mentioning that nicotinic acid/laropiprant increases MPV.…”

mentioning

confidence: 99%