Correlation between coagulation and inflammation state in patients with diabetes mellitus type 2 in relation to gender differences: is there any impact of eight-week exercise training?

  • Divna Trebinjac Oslo University Hospital
  • Ivana Petronic Tirsova University Hospital, Beograd, Serbia
  • Nebojsa Lalic Faculty of Medicine, University of Belgrade
  • Dejan Nikolic Tirsova University Hospital, Beograd, Serbia
Keywords: diabetes mellitus, type 2, blood coagulation, inflammation, exercise, sex

Abstract


Abstract

 

Background/Aim. The hypercoagulable state and in­flammation state in diabetics has been widely studied by previous researchers, but there is a lack of research about a possible impact of exercise training on this rela­tionship. The aim of this study was to assess and com­pare correlation between the coagulation and inflamma­tion status in patients with type 2 diabetes mellitus tak­ing into account the gender differences as well as an im­pact of the 8-week exercise training on the correlation coefficient and parameters of the inflammation and co­agulation state. Methods. A total of 60 patients in stable clinical condition and well-regulated diabetic status passed through all phases of the study. The exercise training included the exercise program as interval train­ing with estimated intensity uphill to 75% of a maximal heart rate in particular individual, 5 times a week for 8 weeks, and walking for 30 minutes with a speed of 5 km/h, 5 times a week for 8 weeks. Further fibrinolytic, coagulation and inflammatory parameters were analyzed before and after the study: D-dimer, von Willebrand fac­tor (vWF), fibrinogen, high sensitivity CRP (hs-CRP), leukocytes, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and coagulation factors: FII, FV, FVII and FX. Results. Our research showed a statistically significant reduction in the mean vWF levels after intervention both at the males (< 0.001) and females (< 0.001). According to a correlation analysis between hs-CRP and fibrinogen, there was a positive correlation as baseline both at the males (< 0.05, r = 0.492) and females (< 0.01, r = 0.516) which became weaker in the males (< 0.01, r = 0.449) and disappeared in the females (< 0.05, r = 0.059) after intervention. The correlation which existed as baseline in the males between D-dimer and either hs-CRP (< 0.01, r = 0.633) or fibrinogen (< 0.01, r = 0.673) as well as the correlation between hs-CRP and FII (< 0.01, r = 0.728), FV (< 0.05, r = 0.366), FVII (< 0.05, r = 0.373) coagulation as well as be­tween D-dimer and FII (< 0.01, r = 0.851), FVII (< 0.05, r = 0.367)was absent in the females. Our re­search demonstrated a weakening correlations in the males after intervention between D-dimer and hs-CRP (< 0.05, r = 0.378), between hs-CRP and FII (< 0.01, r = 0.501), FV (< 0.05, r = 0.298), FVII (< 0.05, r = 0.351) as well as between D-dimer and FII (< 0.01, r = 0.759), and FVII (< 0.05, r = 0.296). The increase of the FX values (< 0.05) in the females after intervention suggested the possible an­tiinflammatory effect of exercise training. Conclusion. According to previous research, the higher levels of vWF was associated with a risk of cardiovascular disease in people with type 2 diabetes mellitus and vWF may be a risk factor unique to these populations. We demon­strated that the 8-week exercise training can significantly reduce the value of vWF in the males and females, sug­gesting a potential beneficial effect on the endothelial function parameters. Our research demonstrated a stronger correlation between the coagulation and in­flammation parameters as baseline in the males than in the females with type 2 diabetes mellitus. According to our results, the 8-week exercise training lead to a weak­ening of the strength of correlation between the coagu­lation and inflammation parameters in the males and complete disappearance of this correlation in the fe­males, suggesting a unique effect of exercise training that should be explored in future research.

Author Biographies

Divna Trebinjac, Oslo University Hospital

Physical Medicine and Rehabilitation Department, University Hospital Ullevål, Oslo, Norway

Ivana Petronic, Tirsova University Hospital, Beograd, Serbia
Professor of Physical Medicine and Rehabilitation and PMR chair, Faculty of Medicine, University of Belgrade, Serbia
Nebojsa Lalic, Faculty of Medicine, University of Belgrade

Dean of Faculty of Medicine, University of Belgrade, and Professor of Internal Medicine, Serbia

Dejan Nikolic, Tirsova University Hospital, Beograd, Serbia
Assistant Professor of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Belgrade, Serbia

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Published
2021/02/11
Section
Original Paper