Effects of troglitazone on coagulation-fibrinolysis abnormalities in patients with type II diabetes mellitus

Type ii diabetes mellitus is frequently complicated by arteriosclerotic disease and by coagulation-fibrinolysis abnormalities, which may be essentially responsible for the development and progression of arteriosclerosis and are positively correlated with insulin resistance. Troglitazone, a drug that improves insulin resistance, was administered to patients with type II diabetes. The effect of troglitazone on coagulation-fibrinolysis abnormalities was observed and compared with that of gliclazide, a sulfonylurea. Twenty-one patients were included in the la-week study; 12 received troglitazone 400 mg/d, and 9 received gliclazide 40 mg/d. Of the 12 patients given troglitazone, 7 were treated with troglitazone only, and 5 received troglitazone and concomitant sulfonylureas. Fasting blood samples were collected before study initiation and after completion of treatment, and variables were measured. After 12 weeks of troglitazone therapy, fasting plasma glucose and hemoglobin A,, levels showed a significant decrease, as did levels of immunoreactive insulin, plasminogen activator inhibitor-1 (PAI-1), and fibrinogen. After gliclazide therapy, fasting plasma glucose and hemoglobin A,, levels showed reductions similar to those produced by troglitazone with a significant increase of immunoreactive insulin, but levels of PAI-1 and fibrinogen showed no decrease. Thus the use of troglitazone in the treatment of patients with type II diabetes produced improvement in increased PAI-1 level and hyperfibrinogenemia as well as in glycemic control. This improvement in glycemic control, hyperinsulinemia, and coagulation-fibrinolysis abnormalities may result in the prevention of vascular complications in these patients. It is also concluded that improvement of glycemic control by gliclazide has little effect on coagulation-fibrinolysis abnormalities.