Diabetes mellitus-associated hyperglycemia is a risk factor for recurring deep vein thrombosis and post-thrombotic syndrome-a cohort study

Objective: Diabetes mellitus (DM) is one of the risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE). However, whether DM-associated hyperglycemia (HG) increases the incidence of recurrence in patients with a history of DVT is unknown. We performed a retrospective cohort study to identify the role of DM-associated HG in predicting DVT complications. Methods: One thousand two hundred and fourteen patients with a first-time diagnosis of DVT in the lower extremity received standard anti-thrombotic therapy in our hospital (from January 2000 through June 2009) and were followed up for at least 60 months. Excluded specific thrombotic comorbidities, 76 cases with DM were enrolled in the DM group, and 181 non-DM patients were added to the nonDM group. Recurrent events, post-thrombotic syndrome (PTS), treatment duration, re-patency of thrombosed lower extremity, and laboratory reports were compared between the groups. Multivariable logistic regression models were used to identify independent predictors of DM-associated HG. Results: Compared to the non-DM subgroup, DM patients with HG (60 patients)were significantly more likely to suffer from a high rate of recurrence (P=0.021) and PTS (P<0.001), an increased HR of recurrence (DM-associated HG among non-DM subgroup, HR=1.34, 95% CI: 1.09-1.63, P=0.025), prolonged treatment duration with anti-thrombotic therapy (P=0.048), decreased re-patency of lower thrombosed extremity (P<0.001), and exacerbation of the inflammatory reaction by a persistently high level of C-reactive protein (CRP) (P=0.012). Conclusion: These results suggest that, among DVT patients, DM with HG is associated with a poor prognosis, possibly due to thrombotic inflammation.