The role of strict metabolic control by insulin infusion on fibrinolytic profile during an acute coronary event in diabetic patients

Background: Many clinical and laboratory observations give support to the hypothesis that strict metabolic control by insulin infusion during acute coronary events may improve the ischemic damage and prognosis. Hypothesis: We investigated the impact of intensive insulin treatment on fibrinolytic parameters during an acute ischemic myocardial event (unstable angina or acute myocardial infarction) in patients with type 2 diabetes mellitus. Methods: The study group consisted of 48 type 2 diabetic patients, of whom 24 were randomized to conventional therapy plus intensive insulin treatment (Group 1) and 24 to conventional therapy only (Group 2). The two groups were comparable according to gender, age, body mass index, waist:hip ratio, duration of diabetes, previous antidiabetic treatment, type of ischemic events, concomitant therapy, and the classic risk factors for coronary disease. Insulin-treated patients were excluded from the study. Plasma levels of fibrinogen, tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) were measured on admission and discharge. Fibrinogen (fibr) was measured using the photometric method. PAI-1 and t-PA were measured by enzyme-linked immunosorbent assays. Results. T-PA increased in both groups during hospitalization (t-PA(admission) vs. t-PA(discharge): Group 1: 15.42 +/- 4.4 ng.ml(-1) vs. 21.2 +/- 5.74 ng.ml(-1), p = 0.000037; Group 2: 14.47 +/- 6.31 ng.ml(-1) vs. 19.18 +/- 6.88 ng.l(-1), p = 0.001). On the other hand, fibr and PAI-1 levels increased remarkably in controls (Group 2, fibr(admission) vs. fibr(discharge): 2.98 +/- 1.04 g.l(-1) vs. 3.59 +/- 1.01 g.l(-1), p = 0.002, and PAI-1(admission) vs. PAI-1(discharge): 30.6 +/- 17.34 ng.ml(-1) vs. 40.62 +/- 23.48 ng.ml(-1), p = 0.003). This finding was not observed in the intensive insulin treatment group (Group 1, fibr(admission) vs fibr(discharge): 2.87 +/- 0.73 g.l(-1) vs. 2.67 +/- 0.72 g.l(-1), p = 0.101, and PAI- 1(admission) vs. PAI-1(discharge): 30.75 +/- 15.81 ng.ml(-1) vs. 27.75 +/- 6.43 ng.ml(-1), p = 0.484). Conclusion: Intensive insulin treatment during an acute coronary event improves fibrinolytic profile in patients with diabetes mellitus. This is a possible mechanism for the reduced short- and long-term mortality in diabetic patients treated with intensive insulin treatment protocol.