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Current Antiplatelet Treatment Strategy in Patients with Diabetes Mellitus
Jung Hwa Jung, Udaya S. Tantry, Paul A. Gurbel, Young-Hoon Jeong
Diabetes Metab J. 2015;39(2):95-113.   Published online April 20, 2015
  • 6,066 View
  • 88 Download
  • 30 Web of Science
  • 24 Crossref
AbstractAbstract PDFPubReader   

Patients with diabetes mellitus (DM) have accelerated atherosclerosis with an increased risk for atherothrombotic cardiovascular complications. A state of high platelet reactivity and activation, hypercoagulability (prothrombotic state) and a subdued response to standard antiplatelet agents may explain high rate of adverse cardiovascular events in patients with DM. Several antithrombotic treatment strategies have been developed to control the prothrombotic state in patients with DM: dose modification of commonly used agents; use of potent agents; and addition of a third antithrombotic drug (triple therapy) to commonly prescribed dual antiplatelet therapy of aspirin and a P2Y12 inhibitor. The present review aims to provide an overview of the current knowledge on platelet abnormalities in patients with DM, focusing on the challenges and perspectives of antiplatelet treatment strategies in this population.


Citations to this article as recorded by  
  • Mice expressing nonpolymerizable fibrinogen have reduced arterial and venous thrombosis with preserved hemostasis
    Woosuk S. Hur, Tomohiro Kawano, Jean Marie N. Mwiza, David S. Paul, Robert H. Lee, Emily G. Clark, Emma G. Bouck, Ananya Dutta, Can Cai, Stephen R. Baker, Martin Guthold, Nigel Mackman, Pierre Mangin, Alisa S. Wolberg, Wolfgang Bergmeier, Matthew J. Flick
    Blood.2024; 143(2): 105.     CrossRef
  • On‐Treatment Platelet Reactivity and Ischemic Outcomes in Patients With Diabetes Mellitus: Two‐Year Results From ADAPT‐DES
    Bahira Shahim, Björn Redfors, Thomas D. Stuckey, Mengdan Liu, Zhipeng Zhou, Bernhard Witzenbichler, Giora Weisz, Michael J. Rinaldi, Franz‐Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Bruce R. Brodie, Iva Srdanovi
    Journal of the American Heart Association.2023;[Epub]     CrossRef
  • Platelet Glycoprotein-Ib (GPIb) May Serve as a Bridge between Type 2 Diabetes Mellitus (T2DM) and Atherosclerosis, Making It a Potential Target for Antiplatelet Agents in T2DM Patients
    Muttia Amalia, Meidi Utami Puteri, Fadlina Chany Saputri, Rani Sauriasari, Bambang Widyantoro
    Life.2023; 13(7): 1473.     CrossRef
  • Polymorphisms of genes related to phase II metabolism and resistance to clopidogrel
    Abdullah Alkattan, Ahmed Alkhalifah, Eman Alsalameen, Fatimah Alghanim, Nashwa Radwan
    Pharmacogenomics.2022; 23(1): 61.     CrossRef
  • Prolonged dual antiplatelet therapy after drug-eluting stent implantation in patients with diabetes mellitus: A nationwide retrospective cohort study
    Seung-Jun Lee, Dong-Woo Choi, Choongki Kim, Yongsung Suh, Sung-Jin Hong, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Eun-Cheol Park, Yangsoo Jang, Chung-Mo Nam, Myeong-Ki Hong
    Frontiers in Cardiovascular Medicine.2022;[Epub]     CrossRef
  • New opportunities of antithrombotic therapy in patients with type 2 diabetes mellitus and stable coronary heart disease for reducing the cardiovascular risk and cardiovascular complications: THEMIS, THEMIS-PCI trials
    Victor I. Kalashnikov, Marina S. Michurova
    Terapevticheskii arkhiv.2022; 94(10): 1204.     CrossRef
  • Ischemic and Bleeding Events of Ticagrelor Monotherapy in Korean Patients With and Without Diabetes Mellitus: Insights From the TICO Trial
    Kyeong Ho Yun, Jae Young Cho, Seung Yul Lee, Sang Jae Rhee, Byeong Keuk Kim, Myeong Ki Hong, Yangsoo Jang, Seok Kyu Oh
    Frontiers in Pharmacology.2021;[Epub]     CrossRef
  • Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore
    Ei Zune The, Mei Yen Ng, Geelyn JL Ng, Bernadette GC Er, Amy ML Quek, Prakash Paliwal, Leonard L Yeo, Bernard PL Chan, Vijay K Sharma, Hock Luen Teoh, Eric YH Khoo, Raymond CS Seet
    Annals of the Academy of Medicine, Singapore.2021; 50(1): 16.     CrossRef
  • Protective Role of Platelets in Myocardial Infarction and Ischemia/Reperfusion Injury
    Kornela Hałucha, Alina Rak-Pasikowska, Iwona Bil-Lula, David J. Chambers
    Cardiology Research and Practice.2021; 2021: 1.     CrossRef
  • Pre- and Post-Conditioning of the Heart: An Overview of Cardioprotective Signaling Pathways
    Denise Coutinho de Miranda, Gabriela de Oliveira Faria, Milla Marques Hermidorff, Fernanda Cacilda dos Santos Silva, Leonardo Vinícius Monteiro de Assis, Mauro César Isoldi
    Current Vascular Pharmacology.2021; 19(5): 499.     CrossRef
  • Post-Transcriptional Expression Control in Platelet Biogenesis and Function
    Carolin T. Neu, Tony Gutschner, Monika Haemmerle
    International Journal of Molecular Sciences.2020; 21(20): 7614.     CrossRef
  • The impact of metformin and aspirin on T-cell mediated inflammation: A systematic review of in vitro and in vivo findings
    Tawanda Maurice Nyambuya, Phiwayinkosi Vusi Dludla, Vuyolwethu Mxinwa, Kabelo Mokgalaboni, Siphamandla Raphael Ngcobo, Luca Tiano, Bongani Brian Nkambule
    Life Sciences.2020; 255: 117854.     CrossRef
  • Short- versus long-term dual antiplatelet therapy after second-generation drug-eluting stent implantation in patients with diabetes mellitus: A meta-analysis of randomized controlled trials
    Hongyu Zhang, Junsong Ke, Jun Huang, Kai Xu, Yun Chen, Timir Paul
    PLOS ONE.2020; 15(12): e0242845.     CrossRef
  • Long non-coding RNA metallothionein 1 pseudogene 3 promotes p2y12 expression by sponging miR-126 to activate platelet in diabetic animal model
    Ming Zhou, Meng Gao, Yanwei Luo, Rong Gui, Hongwen Ji
    Platelets.2019; 30(4): 452.     CrossRef
  • Circulating blood cells and extracellular vesicles in acute cardioprotection
    Sean M Davidson, Ioanna Andreadou, Lucio Barile, Yochai Birnbaum, Hector A Cabrera-Fuentes, Michael V Cohen, James M Downey, Henrique Girao, Pasquale Pagliaro, Claudia Penna, John Pernow, Klaus T Preissner, Péter Ferdinandy
    Cardiovascular Research.2019; 115(7): 1156.     CrossRef
  • Comparison of 1-year clinical outcomes between prasugrel and ticagrelor versus clopidogrel in type 2 diabetes patients with acute myocardial infarction underwent successful percutaneous coronary intervention
    Kye Taek Ahn, Seok-Woo Seong, Ung Lim Choi, Seon-Ah Jin, Jun Hyung Kim, Jae-Hwan Lee, Si Wan Choi, Myung Ho Jeong, Shung Chull Chae, Young Jo Kim, Chong Jin Kim, Hyo-Soo Kim, Myeong-Chan Cho, Hyeon-Cheol Gwon, Jin-Ok Jeong, In-Whan Seong
    Medicine.2019; 98(11): e14833.     CrossRef
  • Fibrin Clot Strength in Patients with Diabetes Mellitus Measured by Thrombelastography
    Benjamin T. Maatman, Glen Schmeisser, Rolf P. Kreutz
    Journal of Diabetes Research.2018; 2018: 1.     CrossRef
  • Role of proprotein convertase subtilisin/kexin type 9 inhibitors in patients with coronary artery disease undergoing percutaneous coronary intervention
    Eliano P. Navarese, Michalina Kołodziejczak, Aniela Petrescu, Bernhard Wernly, Michael Lichtenauer, Alexander Lauten, Antonino Buffon, Wojciech Wanha, Vincenzo Pestrichella, Gennaro Sardella, Gaetano Contegiacomo, Udaya Tantry, Kevin Bliden, Jacek Kubica,
    Expert Review of Cardiovascular Therapy.2018; 16(6): 419.     CrossRef
  • Cardioprotective Properties of Human Platelets Are Lost in Uncontrolled Diabetes Mellitus: A Study in Isolated Rat Hearts
    Isabella Russo, Saveria Femminò, Cristina Barale, Francesca Tullio, Stefano Geuna, Franco Cavalot, Pasquale Pagliaro, Claudia Penna
    Frontiers in Physiology.2018;[Epub]     CrossRef
  • Aortic thrombosis in dogs
    Trevor P.E. Williams, Scott Shaw, Adam Porter, Larry Berkwitt
    Journal of Veterinary Emergency and Critical Care.2017; 27(1): 9.     CrossRef
  • Challenges in Patients with Diabetes: Improving Clinical Outcomes After Percutaneous Coronary Intervention Through EVOlving Stent Technology
    Robert A Byrne, Shmuel Banai, Roisin Colleran, Antonio Colombo
    Interventional Cardiology Review.2017; 13(01): 40.     CrossRef
  • Adding CABG to the Dual Antiplatelet Salad
    Glenn N. Levine, Faisal G. Bakaeen
    Journal of the American College of Cardiology.2017; 69(2): 128.     CrossRef
  • The association between arterial stiffness and tongue manifestations of blood stasis in patients with type 2 diabetes
    Po-Chi Hsu, Yu-Chuen Huang, John Y. Chiang, Hen-Hong Chang, Pei-Yung Liao, Lun-Chien Lo
    BMC Complementary and Alternative Medicine.2016;[Epub]     CrossRef
  • Platelet phenotype changes associated with breast cancer and its treatment
    Chris E. Holmes, Jamie E. Levis, David J. Schneider, Nadia M. Bambace, Deva Sharma, Inder Lal, Marie E. Wood, Hyman B. Muss
    Platelets.2016; 27(7): 703.     CrossRef
Original Article
Clinical Significance of the Presence of Autonomic and Vestibular Dysfunction in Diabetic Patients with Peripheral Neuropathy
Soo Kyoung Kim, Kyeong Ju Lee, Jong Ryeal Hahm, Sang Min Lee, Tae Sik Jung, Jung Hwa Jung, Sungsu Kim, Deok Ryong Kim, Seong-Ki Ahn, Won-Hee Choi, Soon Il Chung
Diabetes Metab J. 2012;36(1):64-69.   Published online February 17, 2012
  • 3,813 View
  • 45 Download
  • 18 Crossref
AbstractAbstract PDFPubReader   

We investigated the prevalence of diabetic autonomic neuropathy (DAN) and vestibular dysfunction (VD) in diabetic patients with peripheral neuropathy.


Thirty-five diabetic patients with peripheral neuropathy were enrolled from August 2008 to July 2009. All subjects underwent autonomic function tests. Nineteen of the patients (54.3%) underwent videonystagmography.


Diabetic autonomic neuropathy was observed in 28 patients (80%). A mild degree of autonomic failure was observed in 18 patients (64.3%), and a moderate degree of autonomic failure was observed in ten patients (35.7%). Factors related to DAN included diabetic nephropathy (P=0.032), degree of chronic kidney disease (P=0.003), and duration of diabetes (P=0.044). Vestibular dysfunction was observed in 11 of 19 patients (57.9%). There was no significant association between DAN and VD.


Diabetic autonomic neuropathy was observed in 28 diabetic patients (80%) with peripheral neuropathy. Vestibular dysfunction was observed in nearly 60% of diabetic patients with peripheral neuropathy who complained of dizziness but showed no significant association with DAN. Diabetic patients who complained of dizziness need to examine both autonomic function and vestibular function.


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  • β-Glucans obtained from fungus for wound healing: A review
    Chunhua Xu, Fengxia Wang, Shibing Guan, Lizhen Wang
    Carbohydrate Polymers.2024; 327: 121662.     CrossRef
  • Dynamic and static balance functions in hemodialysis patients and non‐dialysis dependent CKD patients
    Nobuyuki Shirai, Suguru Yamamoto, Yutaka Osawa, Atsuhiro Tsubaki, Shinichiro Morishita, Ichiei Narita
    Therapeutic Apheresis and Dialysis.2023; 27(3): 412.     CrossRef
  • Micro (mi) RNA and Diabetic Retinopathy
    Sadashiv, Praveen Sharma, Shailendra Dwivedi, Sunita Tiwari, Pankaj Kumar Singh, Amit Pal, Sandeep Kumar
    Indian Journal of Clinical Biochemistry.2022; 37(3): 267.     CrossRef
  • Physiotherapists’ Perspectives on Type 2 Diabetes Management and as a Primary Condition for Referral to Physiotherapy Services: A Qualitative Descriptive Study
    Sarah M. Janssen, Denise M. Connelly, Heather Gillis
    Physiotherapy Canada.2022;[Epub]     CrossRef
  • Subclinical vestibular dysfunction in type 1 diabetes mellitus
    Abdollah Moossavi, Moslem Shaabani, Ensieh Nasli Esfahani, Mohsen Vahedi, Zakaria Enayati
    Hearing, Balance and Communication.2021; 19(2): 86.     CrossRef
  • Potential Applications of Nanomaterials and Technology for Diabetic Wound Healing

    Que Bai, Kai Han, Kai Dong, Caiyun Zheng, Yanni Zhang, Qianfa Long, Tingli Lu
    International Journal of Nanomedicine.2020; Volume 15: 9717.     CrossRef
  • Recent advancements in biopolymer and metal nanoparticle-based materials in diabetic wound healing management
    Veena Vijayakumar, Sushanta K. Samal, Smita Mohanty, Sanjay K. Nayak
    International Journal of Biological Macromolecules.2019; 122: 137.     CrossRef
  • Auditory function and motor proficiency in type 1 diabetic children: A case-control study
    Jalali Mir Mohammad, Soleimani Robabeh, Koohmanai Shahin, Tizno Saeed, Akbari Maryam
    International Journal of Pediatric Otorhinolaryngology.2018; 109: 7.     CrossRef
  • Vestibular profile of type 1 versus type 2 chronic diabetes mellitus
    Ola Abdallah Ibraheem, Mohammad Ramadan Hassaan, Mayada Mohamed Mousa
    Hearing, Balance and Communication.2017; 15(3): 133.     CrossRef
  • Glycemic variability is an important risk factor for cardiovascular autonomic neuropathy in newly diagnosed type 2 diabetic patients
    Wen Xu, Yanhua Zhu, Xubin Yang, Hongrong Deng, Jinhua Yan, Shaoda Lin, Huazhang Yang, Hong Chen, Jianping Weng
    International Journal of Cardiology.2016; 215: 263.     CrossRef
  • Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System
    Linda J. D'Silva, James Lin, Hinrich Staecker, Susan L. Whitney, Patricia M. Kluding
    Physical Therapy.2016; 96(3): 400.     CrossRef
  • Shedding light on miR-26a: Another key regulator of angiogenesis in diabetic wound healing
    Carlos Zgheib, Kenneth W. Liechty
    Journal of Molecular and Cellular Cardiology.2016; 92: 203.     CrossRef
  • Augmented asymmetrical visual field dependence in asymptomatic diabetics: Evidence of subclinical asymmetrical bilateral vestibular dysfunction
    Rima Abdul Razzak, Jeffery Bagust, Sharon Docherty, Wiam Hussein, Abdullah Al-Otaibi
    Journal of Diabetes and its Complications.2015; 29(1): 68.     CrossRef
  • Associations between autonomic dysfunction and pain in chemotherapy‐induced polyneuropathy
    H. Nahman‐Averbuch, Y. Granovsky, E. Sprecher, M. Steiner, T. Tzuk‐Shina, D. Pud, D. Yarnitsky
    European Journal of Pain.2014; 18(1): 47.     CrossRef
  • Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review
    Xi Pan, Jiao-jiao Bai
    International Journal of Nursing Sciences.2014; 1(4): 441.     CrossRef
  • Synkope aus der Sicht des Neurologen
    A. Bickel, J. Röther
    Herz.2014; 39(4): 443.     CrossRef
  • The Role of MicroRNAs in Diabetic Complications—Special Emphasis on Wound Healing
    João Moura, Elisabet Børsheim, Eugenia Carvalho
    Genes.2014; 5(4): 926.     CrossRef
  • Recent advances on the development of wound dressings for diabetic foot ulcer treatment—A review
    Liane I.F. Moura, Ana M.A. Dias, Eugénia Carvalho, Hermínio C. de Sousa
    Acta Biomaterialia.2013; 9(7): 7093.     CrossRef
The Classification of Diabetic Patients Presenting Diabetic Ketoacidosis: The Characteristics of Fulminant Type 1 Diabetes.
Tae Sik Jung, Jong Ryeal Hahm, Jung Hwa Jung, Soon Il Chung
Korean Diabetes J. 2008;32(6):534-536.   Published online December 1, 2008
  • 1,866 View
  • 23 Download
  • 1 Crossref
AbstractAbstract PDF
No abstract available.


Citations to this article as recorded by  
  • A Case of Fulminant Type 1 Diabetes Mellitus in an Elderly Patient
    Seung Min Woo, Seung Hyun Hong, Sung Yun Lee, Su Heui Lee, Duc Ky Lee, Sae Jeong Yang
    The Journal of Korean Diabetes.2015; 16(3): 225.     CrossRef
Original Articles
Effects of Islet Transplantation on Endogenous beta-cell Regeneration after Partial Pancreatectomy in Rodents.
Hye Seung Jung, You Ran Ahn, Seung Hoon Oh, Jung Hwa Jung, Tae Hyun Kim, You Cheol Hwang, Mira Kang, Yongsuk Bae, Young seok Kim, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim
Korean Diabetes J. 2007;31(2):113-122.   Published online March 1, 2007
  • 2,225 View
  • 20 Download
AbstractAbstract PDF
Islet transplantation is one of regimens supplying the deficient insulin in diabetes patients, but the effects of islet grafts on the changes of endogenous beta-cells are not clear. In the present study, we examined the changes of endogenous beta-cell mass after islet transplantation in partially pancreatectomized mice. METHODS: Balb/c mice were 70% pancreatectomized, transplanted with syngeneic islets (group IV), and were compared with pancreatectomized mice treated with insulin (group III) or no insulin (group II). Blood glucose levels and body weight were monitored. Remnant pancreas was obtained at 6 or 10 days after pancreatectomy, and immunohistochemical staining was done for the evaluation of beta-cell mass changes. RESULTS: Hyperglycemia and weight loss were induced after pancreatectomy. After islet transplantation or insulin treatment, blood glucose levels recovered to normal, and body weight started to increase. Plasma insulin levels were higher and beta-cell mass was larger in group IV than in group II (P < 0.05). Especially, the difference of beta-cell mass between them was more evident at 7 days as compared to at 3 day after transplantation. When compared to group III, group IV showed larger individual beta-cell area after 7 days and larger beta-cell mass after 3 days of islet transplantation (P < 0.05). CONCLUSION: These observations indicate that islet transplantation plays a role in enhancing remnant beta-cell regeneration after partial pancreatectomy in rodents.
A Case of Newly Diagnosed Type 2 Diabetes Mellitus Presenting with Rhinocerebral Mucormycosis.
Jung Hwa Jung, Jong Ryeal Hahm, Mi Yeon Kang, Sung Won Moon, Tae Sik Jung, Deok Ryong Kim, Soon Il Chung
Korean Diabetes J. 2004;28(3):225-230.   Published online June 1, 2004
  • 1,011 View
  • 18 Download
AbstractAbstract PDF
Rhinocerebral mucormycosis(RM) is a rare opportunistic fungal infection that mainly occurs in immunocompromised or diabetic patients, but rarely in healthy indi-viduals. This fungal infection usually begins at the nose and progresses through the paranasal sinuses, and secondarily invading the orbit and central nervous system. Because of its rapid progression and high mortality, early diagnosis and treatment are crucial to increase the patient survival rate. A combination of ampho-tericin B administration and surgery is a standard repertoire of RM treatment. Herein, a case in which a 69-year-old male patient with type 2 diabetes mellitus, presentings as RM, is reported. This patient had never been diagnosed with diabetes mellitus until the diabetes and RM were identified by us using the oral glucose tolerance test, measurement of the glycated hemoglobin level and a paranasal sinus CT scan. The RM was further confirmed by a biopsy of an oral mucosal ulcerative lesion. This case suggests that RM can present in newly diagnosed type 2 diabetes patients.

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