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. 2021 Apr 15;16(4):e0250090.
doi: 10.1371/journal.pone.0250090. eCollection 2021.

Plasminogen Activator Inhibitor-1 in poorly controlled vs well controlled Type-2 Diabetes Mellitus patients: A case-control study in a district hospital in Ghana

Charles Nkansah  1   2 , Otchere Addai-Mensah  1 , Kofi Mensah  1   3 , Michael Owusu  1 , Richard K D Ephraim  4 , Patrick Adu  4 , Felix Osei-Boakye  1   5 , Samuel K Appiah  1   6 , Dorcas Serwaa  7 , Charles A Derigubah  1   8 , Alexander Yaw Debrah  1
Affiliations

Plasminogen Activator Inhibitor-1 in poorly controlled vs well controlled Type-2 Diabetes Mellitus patients: A case-control study in a district hospital in Ghana

Charles Nkansah et al. PLoS One. .

Abstract

Background: Hypofibrinolysis resulting from the up-regulation of plasminogen activator inhibitor-1 (PAI-1) usually occurs in patients with type 2 diabetes mellitus (T2DM), rendering them hypercoagulable. This study assessed the plasma antigen and activity levels of the PAI-1 enzyme in T2DM patients in a district hospital in Ghana.

Methods: This was a hospital-based case-control study conducted from December 2018 to May 2019 at Nkenkaasu District Hospital. Sixty subjects with T2DM (30 T2DM subjects with good glycemic control and 30 with poor glycemic control), and 30 apparently healthy blood donors were recruited into the study. Blood specimens were collected for complete blood count, lipid profile, PAI-1 Ag and PAI-1 activity levels. A pre-tested questionnaire was used to obtain demographic and clinical information. The data was analyzed using SPSS version 22.0.

Results: Elevated PAI-1 Ag and activity levels were observed in the T2DM subjects compared to the healthy controls, with the levels and activity significantly higher (PAI-1 Ag; p< 0.001, PAI-1 activity level; p = 0.004) in the T2DM subjects with poor glycemic control in comparison to those with good glycemic control. A significant positive correlation was observed between HbA1c and PAI-1 enzymes. PAI-1 Ag levels significantly increased along with increased total cholesterol (Β = 0.262, p = 0.033), triglyceride (Β = -0.273, p = 0.034) and HbA1c (Β = 0.419, p = 0.001). Similarly, PAI-1 activity level was associated with total cholesterol (Β = 0.325, p = 0.009), triglyceride (Β = -0.262, p = 0.042), HbA1c (Β = 0.389, p = 0.003) and VLDL-c (Β = -0.227, p = 0.029).

Conclusion: PAI-1 antigen/activity is enhanced in poorly controlled Ghanaian T2DM subjects. The hypercoagulable state of the affected individuals put them at higher risk of developing cardiovascular diseases. Good glycemic control to regulate plasma PAI-1 levels is essential during T2DM lifelong management. Markers of fibrinolysis should be assessed in these individuals and appropriate anticoagulants given to prevent thrombosis and adverse cardiovascular diseases.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Correlation between Plasminogen Activator Inhibitor-1 antigen level and glycated hemoglobin among the study participants levels.
HbA1c = Glycated hemoglobin, PAI-1 Ag = Plasminogen activator inhibitor 1 antigen, r = Correlation coefficient. Spearman correlation was used to determine the correlation between the plasma PAI-1 antigen and HbA1c. p<0.05 was considered statistically significant.
Fig 2
Fig 2. Correlation between Plasminogen Activator Inhibitor-1 activity level and glycated hemoglobin among the study participants.
HbA1c = Glycated hemoglobin, PAI-1 = Plasminogen activator inhibitor 1, r = Correlation coefficient. Spearman correlation was used to determine the correlation between the plasma PAI-1 activity level and HbA1c. p<0.05 was considered statistically significant.
Fig 3
Fig 3. Correlation between Plasminogen Activator Inhibitor-1 and fasting blood glucose among the study participants levels.
FBG = fasting blood glucose, PAI-1 Ag = Plasminogen activator inhibitor 1 antigen, r = Correlation coefficient. Spearman correlation was used to determine the correlation between the plasma PAI-1 antigen and FBG (Fig 3a) and PAI-1 activity and FBG (Fig 3b). p<0.05 was considered statistically significant.
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