Plasma Protein Binding of Lidocaine and Warfarin in Insulin-Dependent and Non-Insulin-Dependent Diabetes Mellitus

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Abstract
We examined the plasma protein binding of an acidic drug (warfarin bound to albumin) and a basic drug [lidocaine (lignocaine) bound to α1-acid glycoprotein] in 15 patients with insulin-dependent diabetes mellitus (IDDM) and 15 matched controls. We also examined protein binding of warfarin and lidocaine in 30 patients with non-insulin-dependent diabetes (NIDDM) and 25 controls. Compared with control, the binding of both warfarin (98.81 ± 0.02 vs 98.57 ± 0.03%, mean ± SEM) and of lidocaine (69 ± 2 vs 58 ± 2%) was significantly reduced in IDDM. This group had lower concentrations of both albumin and α1-acid glycoprotein (AAG), achieving statistical significance vs control for albumin only. In the patients with NIDDM, who had a similar level of glycosylated haemoglobin, while there was no significant difference in the binding of lidocaine there was a significant increase in warfarin binding compared with the control population (99.01 ± 0.03 vs 98.82 ± 0.04%). This study suggests that binding of both acidic and basic drugs is altered in both IDDM and NIDDM.