|ISSN No. 1606-7754 Vol.16 No.3 December 2008|
Gender: does it have a role in bleeding time in Caucasians with well controlled type 2 diabetes?
DE Barre, KA Mizier-Barre, O Griscti, K Hafez
Department of Health Studies, Cape Breton University, Sydney, Nova Scotia, Canada
Background: Bleeding times are decreased in type 2 diabetics presenting an enhanced risk of myocardial infarction and subsequent death. It is controversial whether males have a greater risk of myocardial infarction and resultant death in type 2 diabetes. Objective: The purpose of this study was to review the literature regarding gender in bleeding time and to test the hypothesis that there would be gender inequality in bleeding time in well-controlled Caucasian Type 2 diabetics in Cape Breton, Nova Scotia. This study revealed significantly shorter bleeding times in males. Thus it may be that males should be more aggressively treated to increase bleeding time and hence to more equitably manage the risk of myocardial infarction and subsequent death. Ultimately it will have to be determined what bleeding time thresholds are suitable for intervention and indeed what the most appropriate intervention is at each threshold and what role gender may play in these features in type 2 diabetics. However, this was only a very small study and a much larger one would answer whether there is gender inequality in bleeding time among persons with well-controlled type 2 diabetes.
Keywords: Bleeding time, diabetes, gender
Cape Breton Island in the province of Nova Scotia, Canada suffers from among the highest rates of type 2 diabetes in Canada, the consequences of which are seen in the overall economy and in the competition for healthcare dollars with other health issues. Consequently it is important to control this disease as much as possible so as to reduce its economic and social impact. There are no reports to date regarding the equity of management of bleeding time anywhere, such information being of clear importance for the medical, economic and social impacts of this disease.
Type 2 diabetes increases the risk of atherosclerosis-induced myocardial infarction and subsequent death.1,2,3 Myocardial infarction may result from the formation of thrombi and/or emboli in type 2 diabetics 4,5 It was hypothesized that as the preponderance of studies show a greater risk of myocardial infarction and subsequent death in male type 2 diabetics, 6,7,8,9 there should be a shorter bleeding time in males. However, other studies show a greater risk of myocardial infarction and subsequent death in female type 2 diabetics.10,11,12
Bleeding time reflects platelet function and activation as well as interactions between endothelial cells in the artery,platelet aggregation and the coagulation pathways.13,14,15
Shortened bleeding time represents enhanced platelet reactivity and aggregation is related to myocardial infarction,16,17,18,19,20 though this view is not universally held. 21,22,23 Nonetheless, risk of thrombosis is predicted by bleeding time.24 Bleeding time is dramatically shorter in type 2 diabetics25 with a corresponding increase in platelet aggregability.26 In healthy individuals there is no gender difference in bleeding times according to Lethagen and Kling 27, though O’Brien28 reports that males have a shorter bleeding time. However, no work has ever been done to assess potential gender difference in bleeding times in type 2 diabetics. The purpose of this work was to determine if there was a significant difference between bleeding times in male versus female Caucasian type 2 diabetics that are well controlled. Ultimately bleeding time thresholds for intervention will have to be established and what intervention is appropriate for each threshold on a gender basis.