Effects of mealtime insulin aspart and bedtime neutral protamine Hagedorn insulin on postprandial coagulation and fibrinolysis in patients with type 2 diabetes

Aim: Acute hyperglycaemia induces coagulation activation in diabetes patients. We hypothesized that rapid-acting insulin has a beneficial postprandial effect on coagulation and fibrinolysis compared with intermediate-acting insulin because of its ability to lower postprandial hyperglycaemia. Methods: This was tested in a parallel controlled study in well-controlled patients with type 2 diabetes assigned to bedtime neutral protamine Hagedorn (NPH) insulin (n = 41) or mealtime insulin aspart (n = 37). They were served standard diabetic meals for breakfast (8: 00 hours) and lunch (12: 00 hours). Blood samples were collected at 7: 40 hours (fasting), 9: 30, 11: 30, 13: 30 and 15: 30 hours and analysed for glucose, activated factor VII (FVIIa), D-dimer, prothrombin fragment 1+ 2 (F1+ 2), tissue plasminogen activator antigen (t-PA) and plasminogen activator inhibitor activity (PAI). Results: The postprandial glucose response differed significantly between insulin regimens with a postprandial increase on NPH insulin and a decrease on insulin aspart. There was a significant postprandial decrease in F1+ 2, PAI and t-PA, and no changes in FVIIa and D-dimer, on both insulin regimens, but with no differences between insulin treatment groups. Conclusions: The rapid-acting insulin analogue aspart and the intermediate-acting insulin NPH had similar postprandial effects on markers of coagulation activation and fibrinolysis despite different effects on postprandial glucose response.