What question did this study set out to answer?

To assess procoagulant activity and associations with cardiovascular risk factors over five years in children and adolescents with type 1 diabetes on intensive insulin therapy compared to healthy controls.

January 14, 2020Pediatric DiabetesOpen Access

Procoagulant activity in children and adolescents on intensive insulin therapy

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Why the study?

Type 1 diabetes is linked with atherothrombosis, but limited data exist regarding procoagulant activity in young individuals.

Does type 1 diabetes on intensified insulin treatment increase procoagulant activity in children and adolescents compared to healthy controls?

Population

314 children/adolescents with type 1 diabetes and 120 healthy controls

Comparison

Type 1 diabetes using intensified insulin treatment vs healthy controls

Design

5-year follow-up study

Follow-up

5 years

Authors

VBVibeke BratsethOslo University Hospital HMHanna Dis MargeirsdottirOslo University Hospital MHMartin HeierGeneral / Preventive / Lipids

Discussion

Member takes

Implication

No excess procoagulant activity in intensively treated youth with T1D; leaves open whether TFPI elevation marks endothelial activation warranting prospective CV studies.

Key Points

To assess procoagulant activity and associations with cardiovascular risk factors over five years in children and adolescents with type 1 diabetes on intensive insulin therapy compared to healthy controls.
Prospective 5-year follow-up study evaluating 314 children and adolescents with type 1 diabetes and 120 healthy controls.
Plasma prothrombin fragment 1+2 (F1+2), D-dimer, tissue-factor-procoagulant-activity (TF-PCA), and tissue-factor-pathway-inhibitor (TFPI) measured by ELISAs alongside HbA1c levels.
F1+2, D-dimer, and TF-PCA did not differ significantly between diabetic participants and controls, nor did they correlate with HbA1c at baseline or the 5-year follow-up.
TFPI levels were significantly elevated in the diabetes cohort versus controls at both baseline and follow-up (both P < .001), correlating positively with HbA1c at both time points (r = 0.221 and r = 0.304, both P < .001).
At follow-up, oral contraceptive users had significantly higher F1+2, D-dimer, and TF-PCA, and lower TFPI compared to non-users (all P < .005); females maintained lower TFPI (P = .017) and trended toward higher F1+2 (P = .052) versus males after adjustment.

Structured PICO

Does type 1 diabetes on intensified insulin treatment increase procoagulant activity in children and adolescents compared to healthy controls?

Population

314 children and adolescents with type 1 diabetes and 120 healthy controls

Intervention

Intensified insulin treatment for type 1 diabetes

Comparator

Healthy controls

Outcome

Procoagulant activity markers (Prothrombin fragment 1+2 [F1+2], D-dimer, tissue-factor-procoagulant-activity [TF-PCA], and tissue-factor-pathway-inhibitor [TFPI])surrogate

Children and adolescents with type 1 diabetes on intensive insulin therapy do not show increased procoagulant activity compared to healthy controls over 5 years, though elevated TFPI suggests increased endothelial activation related to hyperglycemia.

Cite This Study

Bratseth et al. (2020) studied this question.

synapsesocial.com/papers/6a913e5eae2c4ed52ef12878 https://doi.org/10.1111/pedi.12978

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Implication

No excess procoagulant activity in intensively treated youth with T1D; leaves open whether TFPI elevation marks endothelial activation warranting prospective CV studies.

Procoagulant activity in children and adolescents on intensive insulin therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Procoagulant activity in children and adolescents on intensive insulin therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider