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. 2020 May;21(3):496-504.
doi: 10.1111/pedi.12978. Epub 2020 Jan 21.

Procoagulant activity in children and adolescents on intensive insulin therapy

Vibeke Bratseth  1   2 , Hanna D Margeirsdottir  3   4 , Martin Heier  3   4 , Svein Solheim  1 , Harald Arnesen  1   2 , Knut Dahl-Jørgensen  2   3   4 , Ingebjørg Seljeflot  1   2
Affiliations

Procoagulant activity in children and adolescents on intensive insulin therapy

Vibeke Bratseth et al. Pediatr Diabetes. 2020 May.

Abstract

Background: Type 1 diabetes is associated with atherothrombosis, but limited data exist on procoagulant activity in the young. We investigated procoagulant activity in children/adolescents with type 1 diabetes using intensified insulin treatment compared with controls in a 5-year follow-up study, and further any associations with cardiovascular risk factors.

Methods: The study included 314 diabetes children/adolescents and 120 healthy controls. Prothrombin fragment 1+2 (F1+2), D-dimer, tissue-factor-procoagulant-activity (TF-PCA), and tissue-factor-pathway-inhibitor (TFPI) were analyzed with ELISAs.

Results: F1+2, D-dimer, and TF-PCA did not differ between the groups or correlate to HbA1c in the diabetes group at either time points. TFPI was significantly higher in the diabetes group compared with controls both at inclusion and follow-up (both P < .001). In the diabetes group, TFPI correlated significantly to HbA1c at both time points (r = 0.221 and 0.304, both P < .001). At follow-up, females using oral contraceptives had significantly elevated F1+2, D-dimer, and TF-PCA and lower TFPI compared to no-users (all P < .005), and females had lower TFPI (P = .017) and higher F1+2 compared with males (P = .052), also after adjusting for the use of oral contraceptives.

Conclusions: The current results show similar procoagulant activity in children/adolescents with type 1 diabetes compared with controls over a 5-year period, indicating that these children using modern intensified insulin treatment are not at high thrombotic risk at younger age. The elevated levels of TFPI in the diabetes group, related to hyperglycaemia, are probably reflecting increased endothelial activation. These findings highlight the significance of optimal blood glucose control in children/adolescents with type 1 diabetes, to maintain a healthy endothelium.

Keywords: childhood diabetes; endothelial dysfunction; hyperglycaemia; procoagulant activity; tissue-factor-pathway-inhibitor.

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References

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