Activation platelet assessment in patients with type 2 Diabetes Mellitus and its association with insulin resistance

The incidence of diabetes mellitus (DM) has increased, becoming a global public health problem. Approximately 415 million people worldwide have DM, causing chronic complications including changes in the state of blood homeostasis. In DM there are circulatory disorders caused by platelet hyperreactivity due to increased adhesion, activation and platelet aggregation, resulting in the release of the content of alpha granules, including β-thromboglobulin (βtg) and platelet-factor-4 (CXCL4), as well as thromboxane B2 (TxB2). Insulin resistance (IR) has been shown to predict DM and atherosclerosis, as well as cardiovascular diseases. One of the methods used for the evaluation of IR is through HOMA index (Homeostasis model assessment). This study aimed to verify changes in coagulation by determining the concentrations of fibrinogen, D-dimers and platelet activation (TxB2, βtg and CXCL4) and associate it with the HOMA model in newly diagnosed type 2 diabetic patients. We recruited 38 newly diagnosed and untreated patients with DM2 and 38 healthy subjects. These patients were stratified into the following HOMA quartiles: HOMA-1 (0.89 to 1.77), HOMA-2 (1.77 to 5.26), HOMA-3 (5.26 to 11.32) and HOMA-4 (11.32 to 18.56). Levels of fibrinogen and D-dimers were measured by immunoturbidimetric method, while TxB2, βtg and CXCL4 were quantified by ELISA technique according to the manufacturers’ recommended protocols. According to the results HOMA values were positively correlated with TxB2 (r = 0.75, p <0.001), βtg (r = 0.75, p <0.001), CXCL4 (r = 0.68, p <0.001), fibrinogen (r = 0.54, p <0.001) and D-dimer (r = 0.52, p <0.001). In addition, increased levels of these markers were observed in the higher HOMA quartiles. These findings suggest that patients newly diagnosed with diabetes have insulin resistance which is related to changes in blood homeostasis and the release of components of platelet granules capable of stimulating the cellular response that can cause atherosclerosis. In conclusion, it may be suggested that elevated levels of HOMA may serve as an alert for possible complications in blood homeostasis and lipid metabolism in newly diagnosed diabetic patients and that may cause future complications that will impact the quality of life of these patients.A incidência de diabetes mellitus (DM) tem aumentado, tornando-se um problema de saúde pública global. Aproximadamente 415 milhões de pessoas em todo o mundo tem DM, causando complicações crônicas incluindo alterações no estado de homeostase sanguínea. No DM ocorrem distúrbios circulatórios devido a hiperreatividade das plaquetas, aumento da adesão, ativação e agregação plaquetária, resultando na liberação do conteúdo dos grânulos alfa, incluindo β-Tromboglobulina (βtg) e fator-4-plaquetário (CXCL4), bem como de tromboxano B2 (TxB2). A resistência à insulina (RI) tem se mostrado como preditora do DM e aterosclerose, bem como de doenças cardiovasculares. Um dos métodos utilizados para a avaliação da RI é através do índice de HOMA (Homeostasis model assessment). Esse trabalho objetivou verificar alterações na coagulação através da determinação das concentrações de fibrinogênio, D-dímeros e ativação plaquetária (TxB2, βtg e CXCL4) e associar com o índice de HOMA em pacientes diabéticos tipo 2 (DM2) recentemente diagnosticados. Foram recrutados 38 pacientes recentemente diagnosticados e não tratados com DM2 e 38 indivíduos saudáveis. Esses pacientes foram estratificados nos seguintes quartis de HOMA: HOMA-1 (0,89 a 1,77), HOMA-2 (1,77 a 5,26), HOMA-3 (5,26 a 11,32) and HOMA-4 (11,32 a 18,56). Níveis de fibrinogênio e D-dimeros foram dosados através de imunoturbidimetria, enquanto TxB2, βtg e CXCL4 foram quantificados por técnica de ELISA de acordo com as recomendações do fabricante. De acordo com os resultados os valores de HOMA foram positivamente correlacionados com TxB2 (r = 0,75, p <0,001), βtg (r = 0,75, p <0,001), CXCL4 (r = 0,68, p <0,001), fibrinogênio (r = 0,54, p <0,001) e D-Dímero (r = 0,52, p