Effects of mealtime insulin aspart and bedtime neutral protamine Hagedorn insulin on postprandial coagulation and fibrinolysis in patients with type 2 diabetes

Aim: Acute hyperglycaemia induces coagulation activation in diabetes patients. We hypothesized that rapid‐acting insulin has a beneficial postprandial effect on coagulation and fibrinolysis compared with intermediate‐acting insulin because of its ability to lower postprandial hyperglycaemia. Methods: This was tested in a parallel controlled study in well‐controlled patients with type 2 diabetes assigned to bedtime neutral protamine Hagedorn (NPH) insulin (n = 41) or mealtime insulin aspart (n = 37). They were served standard diabetic meals for breakfast (8:00 hours) and lunch (12:00 hours). Blood samples were collected at 7:40 hours (fasting), 9:30, 11:30, 13:30 and 15:30 hours and analysed for glucose, activated factor VII (FVIIa), D‐dimer, prothrombin fragment 1+2 (F1+2), tissue plasminogen activator antigen (t‐PA) and plasminogen activator inhibitor activity (PAI). Results: The postprandial glucose response differed significantly between insulin regimens with a postprandial increase on NPH insulin and a decrease on insulin aspart. There was a significant postprandial decrease in F1+2, PAI and t‐PA, and no changes in FVIIa and D‐dimer, on both insulin regimens, but with no differences between insulin treatment groups. Conclusions: The rapid‐acting insulin analogue aspart and the intermediate‐acting insulin NPH had similar postprandial effects on markers of coagulation activation and fibrinolysis despite different effects on postprandial glucose response.