TY - JOUR
T1 - Hemostatic Effects of Exercise-Related Hypoglycemia in Male Persons With Type 1 Diabetes
AU - Hagelqvist, Per Gustav
AU - Andersen, Andreas
AU - Maytham, Kaisar
AU - Andreasen, Christine Rode
AU - Engberg, Susanne
AU - Pedersen-Bjergaard, Ulrik
AU - Forman, Julie Lyng
AU - Johansson, Pär
AU - Lykkesfeldt, Jens
AU - Knop, Filip Krag
AU - Vilsbøll, Tina
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.
PY - 2024/10/15
Y1 - 2024/10/15
N2 - CONTEXT: People with type 1 diabetes (T1D) are at increased risk of thrombosis compared to the general population; however, the underlying mechanisms remain unclear. Hypoglycemia induced at rest can induce coagulation activation, but little is known about the hemostatic effects of exercise-related hypoglycemia in people with T1D.OBJECTIVE: We compared hemostatic profiles of individuals with T1D with healthy controls and explored hemostatic effects of hypoglycemia, induced with or without exercise, in participants with T1D.METHODS: Thrombelastography was used for a baseline hemostatic comparison between fifteen men with T1D and matched healthy controls. In addition, the participants with T1D underwent two euglycemic-hypoglycemic clamp days in a randomized, crossover fashion. Hypoglycemia was induced with the participants at rest (Hypo-rest) or during exercise (Hypo-exercise). Thrombelastography provides data on the rate of coagulation activation (R-time), the rate of clot formation (K-time, α-Angle), the maximum clot amplitude (MA), the functional fibrinogen contribution to the clot strength (MA-FF) and the fibrinolysis (LY-30).RESULTS: The T1D group exhibited a faster rate of coagulation activation (shorter R-time) and a faster clot formation (greater α-Angle) compared with the controls. During the clamp experiments, Hypo-exercise induced an increased clot strength (MA) with a mean difference from baseline of 2.77 mm (95% CI, 2.04-3.51) accompanied with a decreased fibrinolysis (LY-30) of -0.45 percentage point (-0.60 to -0.29). Hypo-rest resulted in increased functional fibrinogen (MA-FF) of 0.74 mm (0.13-1.36) along with an increased fibrinolysis (LY-30) of 0.54 percentage point (0.11-0.98).CONCLUSION: Individuals with T1D exhibit a hypercoagulable hemostatic profile compared with healthy controls and exercise-related hypoglycemia may increase the susceptibility to thrombosis via both procoagulant and antifibrinolytic effects.
AB - CONTEXT: People with type 1 diabetes (T1D) are at increased risk of thrombosis compared to the general population; however, the underlying mechanisms remain unclear. Hypoglycemia induced at rest can induce coagulation activation, but little is known about the hemostatic effects of exercise-related hypoglycemia in people with T1D.OBJECTIVE: We compared hemostatic profiles of individuals with T1D with healthy controls and explored hemostatic effects of hypoglycemia, induced with or without exercise, in participants with T1D.METHODS: Thrombelastography was used for a baseline hemostatic comparison between fifteen men with T1D and matched healthy controls. In addition, the participants with T1D underwent two euglycemic-hypoglycemic clamp days in a randomized, crossover fashion. Hypoglycemia was induced with the participants at rest (Hypo-rest) or during exercise (Hypo-exercise). Thrombelastography provides data on the rate of coagulation activation (R-time), the rate of clot formation (K-time, α-Angle), the maximum clot amplitude (MA), the functional fibrinogen contribution to the clot strength (MA-FF) and the fibrinolysis (LY-30).RESULTS: The T1D group exhibited a faster rate of coagulation activation (shorter R-time) and a faster clot formation (greater α-Angle) compared with the controls. During the clamp experiments, Hypo-exercise induced an increased clot strength (MA) with a mean difference from baseline of 2.77 mm (95% CI, 2.04-3.51) accompanied with a decreased fibrinolysis (LY-30) of -0.45 percentage point (-0.60 to -0.29). Hypo-rest resulted in increased functional fibrinogen (MA-FF) of 0.74 mm (0.13-1.36) along with an increased fibrinolysis (LY-30) of 0.54 percentage point (0.11-0.98).CONCLUSION: Individuals with T1D exhibit a hypercoagulable hemostatic profile compared with healthy controls and exercise-related hypoglycemia may increase the susceptibility to thrombosis via both procoagulant and antifibrinolytic effects.
KW - Adult
KW - Blood Coagulation/physiology
KW - Blood Glucose/analysis
KW - Case-Control Studies
KW - Cross-Over Studies
KW - Diabetes Mellitus, Type 1/blood
KW - Exercise/physiology
KW - Fibrinolysis/physiology
KW - Glucose Clamp Technique
KW - Hemostasis/physiology
KW - Humans
KW - Hypoglycemia/blood
KW - Male
KW - Thrombelastography
KW - Thrombosis/etiology
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85206596036&partnerID=8YFLogxK
U2 - 10.1210/clinem/dgae278
DO - 10.1210/clinem/dgae278
M3 - Journal article
C2 - 38642404
SN - 0021-972X
VL - 109
SP - 2735
EP - 2744
JO - The Journal of clinical endocrinology and metabolism
JF - The Journal of clinical endocrinology and metabolism
IS - 11
ER -