Insulin resistance and changes in the blood coagulation-fibrinolysis system after a glucose clamp technique in patients with type 2 diabetes mellitus.

We investigated the relationship between changes in insulin resistance and blood coagulation-fibrinolysis following institution of a glucose clamp (GC) in patients with type 2 diabetes mellitus. We studied 35 type 2 diabetic patients (19 males and 16 females, mean age at 58.3 +/- 11.9 years) and 10 healthy subjects. The hyperinsulinemic euglycemic GC technique was performed using on artificial pancreas. The degree of insulin resistance was determined from the glucose infusion rate (GIR) calculated from the GC technique. The GIR in type 2 diabetic patients was markedly reduced compared to that in healthy subjects. The GIR was significantly and negatively correlated with the body mass index and the serum concentrations of the fasting immunoreactive insulin (FIRI). The plasma concentrations of thrombomodulin (TM) and tissue plasminogen activator (tPA) in the diabetic patients were significantly higher than those in the healthy subjects. The plasma concentrations of plasminogen activator inhibitor 1 in the diabetic patients tended toward higher than those in the healthy subjects. The elevated plasma concentrations of TM and tPA in diabetes were significantly lowered following a GC technique. Patients with advanced nephropathy had significant higher concentrations of TM and tPA compared to healthy subjects. We concluded that diabetic patients have abnormalities in the blood coagulation-fibrinolytic system that can be improved by the GC technique.