Effects of hyperglycemia and hyperinsulinemia on the tissue factor pathway of blood coagulation

Curr Diab Rep. 2007 Jun;7(3):223-7. doi: 10.1007/s11892-007-0035-1.


Tissue factor (TF) is the primary initiator of blood coagulation. Circulating TF procoagulant activity (TF-PCA) is associated with blood cells and microparticles and is elevated in patients with type 2 diabetes mellitus. Combined hyperinsulinemia and hyperglycemia and to a lesser degree selective hyperinsulinemia for 24 hours in healthy volunteers increased circulating TF-PCA, monocyte TF surface expression and mRNA, plasma thrombin generation, and coagulation factors VII and VIII activities, suggesting that the coagulation system had been activated. In addition, platelet CD40L and platelet-monocyte aggregates increased, indicating platelet activation. Somatostatin abolished these changes. We conclude that hyperinsulinemia, but particularly the combination of hyperinsulinemia and hyperglycemia, creates a prothrombotic state and may, in addition, be proinflammatory and proatherogenic by virtue of the actions of CD40L and TF.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Blood Coagulation / physiology*
  • Diabetes Mellitus, Type 2 / blood*
  • Humans
  • Hyperglycemia / blood*
  • Hyperinsulinism / blood*
  • Somatostatin / pharmacology
  • Thromboplastin / metabolism*


  • Somatostatin
  • Thromboplastin