Viscoelasticity as a measurement of clot structure in poorly controlled type 2 diabetes patients: towards a precision and personalized medicine approach - PubMed (original) (raw)

Viscoelasticity as a measurement of clot structure in poorly controlled type 2 diabetes patients: towards a precision and personalized medicine approach

Etheresia Pretorius et al. Oncotarget. 2016.

Abstract

Objectives: Type 2 diabetes patients (T2D) have a considerably higher cardiovascular risk, which is closely associated with systemic inflammation, and an accompanying pathologic coagulation system. Due to the complexity of the diabetic profile, we suggest that we need to look at each patient individually and particularly at his or her clotting profile; as the healthiness of the coagulation system gives us an indication of the success of clinical intervention.

Results: T2D coagulability varied markedly, although there were no clear difference in medication use and the standards of HbA1c levels.

Research design and methods: Our sample consisted of 90 poorly controlled T2D and 71 healthy individuals. We investigated the medication use and standards of HbA1c levels of T2D and we used thromboelastography (TEG) and scanning electron microscopy (SEM) to study their clot formation.

Conclusion: The latest NIH guidelines suggest that clinical medicine should focus on precision medicine, and the current broad understanding is that precision medicine may in future, provide personalized targets for preventative and therapeutic interventions. Here we suggest a practical example where TEG can be used as an easily accessible point-of-care tool to establish a comprehensive clotting profile analysis for T2D patients; and additionally may provide valuable information that may be used in the envisaged precision medicine approach. Only by closely following each individual patient's progress and healthiness and thereby managing systemic inflammation, will we be able to reduce this pandemic.

Keywords: Pathology Section; coagulation; personalized medicine approach; precision medicine; viscoelasticity; type 2 diabetes.

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Conflict of interest statement

The authors (EP and JB) do not have any conflict of interest to declare.

Figures

Figure 1

Figure 1

A. Healthy control plasma coagulation TEG trace showing the different parameters: R: Reaction time, first measurable clot formation; K: Achievement of clot firmness; Angle: Kinetics of clot development; MA: Maximum clot strength; MRTG: Maximum rate of thrombus generation; TMRTG: Time to maximum rate of thrombus generation; TTG: Final clot strength. B. Healthy TEG trace shown in green projected onto the 4 different trace types seen in type 2 diabetes.

Figure 2

Figure 2

A. A typical healthy fibrin fibre net versus B. to E.) typical type 2 diabetes fibrin fiber nets according to the four types identified with TEG. (Numbers in the top left corner correspond with patient number in Table 3). Scale bar: 1 μm.

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