Diabetes as a Prothrombotic State

Abstract

Both type 1 and type 2 diabetes are prothrombotic states. This state is contributed by both hyperglycaemia and hyperinsulinaemia that characterize type 2 diabetes and hyperglycaemia only in type one diabetes. All phases of blood coagulation are affected in this disease. Increase in procoagulant factors, increased tissue factor, reduced natural inhibitors of coagulation, platelet hyper reactivity, endothelial cell dysfunction, increased blood viscosity, increased red cell membrane rigidity and dysbalanced adipokines and other proinflammatory cytokines along with accelerated microparticle generation and autoimmunity in the form of anti apolipoprotein antibody contributes to acquired prothrombotic state of the disease. A proportion of such patients also have inherited thrombophilia and antiphospholipid antibodies. Acquired complications of diabetes ie, atherosclerosis, micro and macrovascular disease leading to end organ dysfunction also aggravate the already existent prothrombotic state in the condition. Improving diabetic control by using a combination of medicines can result in a favorable thrombohaemorrhagic profile in addition to lowering of blood sugar g and insulinomimetic properties. In addition, drugs which control dyslipidaemia and improves endothelial health and reduces platelet hyperreactivity along with blood pressure control will reduce the thrombophilic tendency and vasodegenerattve propensity in this disease. These treatments when combined with proper diet and exercise will normalise thrombohaemorrhagic balance in this disease and will holistically improve the health of the patient.