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      Evaluation of Serum Fibrinogen, Plasminogen, α 2-Anti-Plasmin, and Plasminogen Activator Inhibitor Levels (PAI) and Their Correlation with Presence of Retinopathy in Patients with Type 1 DM

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          Abstract

          Background. Diabetic retinopathy (DR) is the leading cause of blindness in the world. Retinopathy can still progress despite optimal metabolic control. The aim of the study was to determine whether different degrees of DR (proliferative or nonproliferative) were associated with abnormally modulated hemostatic parameters in patients with T1DM. Method. 52 T1DM patients and 40 healthy controls were enrolled in the study. Patients were subdivided into three categories. Group I was defined as those without retinopathy, group II with NPRP, and group III with PRP. We compared these subgroups with each other and the control group (Group IV) according to the serum fibrinogen, plasminogen, alpha2-anti-plasmin ( α 2-anti-plasmin), and PAI. Results. We detected that PAI-1, serum fibrinogen, and plasminogen levels were similar between the diabetic and control groups ( P = 0.209, P = 0.224, and P = 0.244, resp.), whereas α 2-anti-plasmin was higher in Groups I, II, and III compared to the control group ( P < 0.01, P < 0.05, and P < 0.001, resp.). There was a positive correlation between serum α 2-anti-plasmin and HbA1c levels ( r = 0,268, P = 0.031). Conclusion. To our knowledge there is scarce data in the literature about α 2-anti-plasmin levels in type 1 diabetes. A positive correlation between α 2-anti-plasmin with HbA1c suggests that fibrinolytic markers may improve with disease regulation and better glycemic control.

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          Most cited references 36

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          The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy.

          To examine the 10-year incidence and progression of diabetic retinopathy. Population-based incidence study. Seven hundred sixty-five insulin-taking diabetic persons diagnosed before age 30 years, 251 insulin-taking diabetic persons diagnosed at age 30 years or older, and 282 non-insulin-taking diabetic persons diagnosed at age 30 years or older who participated in baseline, 4-year, and 10-year follow-up examinations. The 10-year incidence of any retinopathy, progression of retinopathy, and progression to proliferative retinopathy were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study severity scheme. The 10-year incidence of retinopathy (89%, 79%, and 67%), progression of retinopathy (76%, 69%, and 53%), and progression to proliferative retinopathy (30%, 24%, and 10%) were highest in the group diagnosed before age 30 years, intermediate in the insulin-taking group diagnosed at age 30 years or older, and lowest in the non-insulin-taking group, respectively. Increased risk of proliferative retinopathy was associated with more severe retinopathy at baseline. These data suggest relatively high 10-year rates of incidence and progression of retinopathy, and despite changes in the treatment of diabetes, there has been little change in the incidence and progression of diabetic retinopathy during the 10-year study period.
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            Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience.

            The influence of fibrinogen on the risk of cardiovascular disease is examined over 16 years of follow-up in 1314 subjects who were initially free of cardiovascular disease in the Framingham Study. Of these subjects, 46 men and 43 women developed diabetes, and 56 men and 53 women had blood sugar levels that exceeded 120 mg/dl. Diabetes predisposed subjects to all of the 408 major cardiovascular disease outcomes. Diabetics had higher levels of fibrinogen, hypertension, hypertriglyceridemia, and obesity, but lower HDL cholesterol values. The influence of diabetes on cardiovascular disease was greatly dependent on these coexistent risk factors, but there was a substantial independent effect of glucose intolerance when all the standard risk factors had been taken into account. There was a rise in fibrinogen values throughout the range of blood sugar levels, which suggests a thrombogenic explanation for the unique diabetic effect. However, multivariate analysis indicates no further reduction in diabetic cardiovascular risk ratios after adjustment for fibrinogen; thus, there is a residual effect for glucose intolerance after all of the standard risk factors and fibrinogen have been taken into account.
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              The Long-Term Effects of Type 1 Diabetes Treatment and Complications on Health-Related Quality of Life

              OBJECTIVE To examine the long-term effects of type 1 diabetes treatment, metabolic control, and complications on health-related quality of life (HRQOL). RESEARCH DESIGN AND METHODS A total of 1,441 participants, initially 13–39 years of age, were followed for an average of 23.5 years as part of the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study. The Diabetes Quality-of-Life questionnaire (DQOL) was administered annually during DCCT and every other year during EDIC. Biomedical data, including HbA1c levels, exposure to severe hypoglycemia, intercurrent psychiatric events, and development of diabetes complications were collected at regular intervals throughout the follow-up. RESULTS Mean total DQOL scores were not significantly different between the former DCCT intensive and conventional treatment groups (DCCT baseline, 78 ± 8 vs. 78 ± 9; EDIC year 17, 75 ± 11 vs. 74 ± 11). Over the course of the study, a drop of ≥5 points in DQOL score from DCCT baseline maintained on two successive visits occurred in 755 individuals and was associated with increased HbA1c, albumin excretion rate, mean blood pressure, BMI, and occurrence of hypoglycemic events requiring assistance. Lower DQOL scores after 23.5 years of follow-up were associated with prior development of retinopathy (P = 0.0196), nephropathy (P = 0.0019), and neuropathy (P < 0.0001) as well as self-reported chest pain (P = 0.0004), decreased vision in both eyes (P = 0.0005), painful paresthesias (P < 0.0001), recurrent urinary incontinence (P = 0.0001), erectile dysfunction (P < 0.0001), and history of psychiatric events (P < 0.0001). CONCLUSIONS Among DCCT/EDIC participants, worsening metabolic control, serious diabetes complications and their associated symptoms, and development of psychiatric conditions led to decreased HRQOL.
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                Author and article information

                Journal
                J Diabetes Res
                J Diabetes Res
                JDR
                Journal of Diabetes Research
                Hindawi Publishing Corporation
                2314-6745
                2314-6753
                2014
                10 April 2014
                : 2014
                Affiliations
                1Endocrinology and Metabolism Department, Ataturk Training and Research Hospital, Yildirim Beyazit University, 6800 Ankara, Turkey
                2Ophthalmology Department, Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
                3Ophtalmology Department, Izzet Baysal Government Hospital, Bolu, Turkey
                4Department of Biochemistry, Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
                Author notes
                *Sefika Burcak Polat: burcakugurlu@ 123456gmail.com

                Academic Editor: Nikolaos Papanas

                Article
                10.1155/2014/317292
                4003747
                24818165
                Copyright © 2014 Sefika Burcak Polat et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Research Article

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