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Procoagulant activity in children and adolescents on intensive insulin therapy
Author(s) -
Bratseth Vibeke,
Margeirsdottir Hanna D.,
Heier Martin,
Solheim Svein,
Arnesen Harald,
DahlJørgensen Knut,
Seljeflot Ingebjørg
Publication year - 2020
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12978
Subject(s) - medicine , insulin , intensive care medicine , pediatrics
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 HbA 1c 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 HbA 1c 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.