@misc{sauls_banini_boyd_hoffman_2007, title={Elevated prothrombin level and shortened clotting times in subjects with type 2 diabetes}, volume={5}, ISSN={["1538-7836"]}, DOI={10.1111/j.1538-7836.2007.02366.x}, abstractNote={The partial thromboplastin time [1] and its successor, the activated partial thromboplastin time (aPTT) [2], have long been used to detect coagulation factor deficiencies and monitor replacement therapy in patients at risk of bleeding. More recently, a correlation has been reported between short aPTT values and the risk of thrombosis [3,4], as well as the risk of recurrence in patients who have already suffered a thromboembolic event [5]. High factor (F)VIII or IX levels can contribute, but are not the only determinants of a short aPTT [6]. An elevated level of prothrombin has also been associated with thrombosis [7], and elevated levels of prothrombin lead to increased thrombin generation in an in vitro model of hemostasis [8]. Thus, it seems likely that elevated prothrombin levels could contribute both to thrombotic risk and to a shortening of the aPTT. Insulin resistance and type 2 diabetes mellitus (DM) are associated with an increased risk of atherothrombotic events [9], as well. In order to determine whether the levels of prothrombin or other plasma clotting factors might play a role in the thrombotic tendency in diabetes, we assayed clotting times, and prothrombin, antithrombin, fibrinogen and plasminogen activator inhibitor-1 (PAI-1) levels in subjects with or without type 2 DM. The prothrombin time (PT) and aPTT assays were performed in the Durham Veterans Affairs Medical Center Clinical Hematology Laboratory on an STA analyzer (Diagnostica Stago, Asnières, France) using Neoplastin (ISI 1.3) and PTT Automate reagents, respectively. The reference range for the PT International Normalized Ratio (INR) is 0.89–1.20 and for the aPTT it is 23.5–35.1 s. Levels of prothrombin, fibrinogen and PAI-1 were determined by ELISA. The subjects were the first 40 of 81 subjects recruited into a trial on the effects of muscadine grape juice on parameters related to glycemic control and cardiovascular risk [10]. This study was conducted under a protocol approved by the Institutional Review Board of North Carolina State University. The details of this study, including subject characterization have been published previously [10]. Blood samples were collected before and after a period during which some of the subjects consumed wine or grape juice. Blood samples collected before the dietary intervention were used to assess coagulation parameters. Subjects were provisionally classified as DM based on their report of having been so diagnosed by a physician. They were subsequently reclassified based on fasting glucose, insulin and glycated hemoglobin (HbA1C) levels. Selfclassification into DM or control groups was verified for all except three subjects, who were excluded from the analysis because the fasting glucose, insulin and HbA1C levels did not allow them to be unambiguously classified. Data from a total of 10 male and 9 female controls, and 8 male and 10 female diabetic subjects were available for analysis. Informed consent was obtained from all participants. We found that DM subjects had shorter values than controls for the aPTT (25.6 ± 3.7 vs. 29.3 ± 3.4 s; P 1⁄4 0.006) and PT assays (11.3 ± 0.5 vs. 11.9 ± 0.6 s; P 1⁄4 0.005). While the differences were small in absolute terms, they were highly statistically significant. In addition, the distribution of the values was different in controls and diabetics. Only the distributions of aPTT values are shown in the top panel of Fig. 1, but the distribution of PT values looked very similar. In addition, male controls tended to have a shorter mean aPTT than females, but the difference did not reach statistical significance. PT values were not different for male and female control subjects. DM subjects also had significantly higher prothrombin levels than controls (1.8 ± 1.2 vs. 1.0 ± 0.3 units mL; P 1⁄4 0.04), and male controls had higher prothrombin levels than female controls (1.22 ± 0.48 vs. 0.83 ± 0.29 units mL; P 1⁄4 0.03). There was also a striking tailing of prothrombin values to the high side of the distribution curve in the diabetic subjects, as shown in the lower panel of Fig. 1. In the diabetic subjects there was a significant inverse correlation between the prothrombin level and the PT and aPTT (r 1⁄4 )0.4 for females and )0.55 for males), which was not found in the control groups. This suggests that the elevated prothrombin level in diabetics is an important contributor to the shortened clotting times. There was no significant difference in fibrinogen, antithrombin or PAI-1 levels between the groups. We believe that the difference in prothrombin level could be responsible for shortening of both the PT and the aPTT. However, because the PT clots so much more rapidly than the Correspondence: Maureane Hoffman, Laboratory Service (113), Durham Veterans Affairs Medical Center, 508 Fulton St, Durham, NC 27705, USA. Tel.: +1 919 286 6925; fax: +1 919 286 6828; e-mail: maureane@ med.unc.edu}, number={3}, journal={JOURNAL OF THROMBOSIS AND HAEMOSTASIS}, author={Sauls, D. L. and Banini, A. E. and Boyd, L. C. and Hoffman, M.}, year={2007}, month={Mar}, pages={638–639} }
 @article{banini_boyd_allen_allen_sauls_2006, title={Muscadine grape products intake, diet and blood constituents of nondiabetic and type 2 diabetic subjects}, volume={22}, ISSN={["1873-1244"]}, DOI={10.1016/j.nut.2006.08.012}, abstractNote={Red wines and grape juices contain polyphenolics with antioxidant and antiplatelet properties that may be protective against oxidative stress leading to hypertension, insulin resistance, and type 2 diabetes (T2D). This study evaluated the effects of supplementing meals of subjects with 150 mL of muscadine grape juice (MJ), muscadine grape wine (MW), and dealcoholized muscadine grape wine (Dz-W) on glycemic indices, blood constituents, lipid profile, anthropometric, and nutrient intakes of healthy and T2D subjects over a 28-d period. Subjects with T2D were assigned to take MJ, MW, or Dz-W. Non-diabetics consumed MJ and controls were given no test drinks. Several metabolic indicators associated with diabetic conditions were measured at baseline and repeated after 28 d. Diabetics given MW and Dz-W showed lower levels of blood glucose, insulin, and glycated hemoglobin, indicating better glycemic control. Elevated dietary vitamin C and E levels were observed in diabetics given Dz-W, indicating improved antioxidant status. Decreased red blood cell membrane saturated fatty acids and increased mono- and polyunsaturated fatty acids for subjects with T2D given MW suggested improved membrane fluidity. Lower sodium and chloride values for subjects T2D given MW suggested lower risk for developing hypertension. Improved hepatic conditions were noted by decreases in alanine aminotransferase and aspartate aminotransferase among subjects with T2D given MW, indicating better insulin sensitivity and decreased tendency toward impaired liver function. Daily intake of 150 mL of MW or Dz-W with meals improved several metabolic responses among diabetics compared with diabetics given MJ.}, number={11-12}, journal={NUTRITION}, author={Banini, Akpene E. and Boyd, Leon C. and Allen, Jonathan C. and Allen, Hengameh G. and Sauls, Derrick L.}, year={2006}, pages={1137–1145} }
 @article{banini_allen_allen_boyd_lartey_2003, title={Fatty acids, diet, and body indices of type II diabetic American whites and blacks and Ghanaians}, volume={19}, ISSN={["0899-9007"]}, DOI={10.1016/S0899-9007(03)00108-4}, abstractNote={This research was designed to study the diet, lipid profile, and metabolic and body indices of type II diabetic and non-diabetic subjects among American white and black and Ghanaian populations.Fifty-one type II diabetic and non-diabetic volunteers were recruited through medical clinics. Data collected included food intake and anthropometric measurement. Blood samples were taken for glucose and serum lipid analyses. Serum non-esterified fatty acids, very low-density lipoproteins, low-density lipoproteins, high-density lipoproteins, total cholesterol, and triacylglycerols levels were measured.The Ghanaian subjects had lower body mass indexes than did the American white and black subjects (P < 0.01), although they recorded the highest carbohydrate intake. Dietary fat intake was not significantly correlated with body fat level or body mass index among the different observational groups. The serum ratio of saturated to polyunsaturated fat was higher in all diabetics than in controls and higher in Ghanaians than in Americans. Total cholesterol, triacylglycerols, and lipoproteins were within normal ranges for diabetic and non-diabetic subjects. The ratio of total cholesterol to high-density lipoprotein cholesterol was slightly elevated among the white diabetics (P < 0.05).The data showed a higher metabolism of carbohydrate for energy in the Ghanaian group than in the other groups. In addition, fat metabolism may differ between Americans and Ghanaians. For many variables, black Americans were more similar to white Americans than to Ghanaians. These observations imply that cultural factors may contribute more than ethnic origin to the etiology of diabetes.}, number={9}, journal={NUTRITION}, author={Banini, AE and Allen, JC and Allen, HG and Boyd, LC and Lartey, A}, year={2003}, month={Sep}, pages={722–726} }