Serum protein binding of phenytoin and valproic acid in insulin-dependent diabetes mellitus

The serum protein binding of valproic acid (VPA) and phenytoin (PHT) was determined in spiked serum samples collected from 17 patients with insulin-dependent diabetes mellitus and 16 healthy control subjects. The free fraction of VPA was significantly greater in patients than in controls (7.6 +/- 1.6% vs. 6.2 +/- 1.2%, p less than 0.01); for PHT, free fraction values were similar in the two groups (8.2 +/- 1.1% vs. 8.4 +/- 1.2%). The free fraction of VPA in diabetic patients was positively correlated with free fatty acid (FFA) concentration (r = 0.79, p less than 0.01). No significant relationships could be found between free drug fraction and either serum albumin or glycosylated protein concentration.