Prevalence of Coagulopathy and its Association with Glycemic Control Complications in Patients with Type 2 Diabetes Mellitus: A Literature Review

Abstract

Type 2 diabetes mellitus (T2DM) is associated with hemostatic abnormalities that may contribute to vascular complications; however, the reported prevalence of coagulopathy and its relationship with glycemic control remain inconsistent across studies. This systematic literature review aimed to synthesize evidence regarding the prevalence of coagulopathy and its associations with glycemic control and diabetes-related complications. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and included searches of Europe PMC and supplementary sources for studies published between 2021 and 2026. A total of 32 articles were included and critically appraised using Joanna Briggs Institute (JBI) appraisal tools. The findings were analyzed through narrative synthesis and bibliometric mapping using VOSviewer. One study reported a coagulopathy prevalence of 26.6%; however, variations in diagnostic definitions and laboratory thresholds precluded a pooled prevalence estimate. Poor glycemic control was associated with elevated fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1), and selected platelet indices, whereas prothrombin time (PT) and activated partial thromboplastin time (aPTT) demonstrated inconsistent patterns. Fibrinogen-related markers were associated with diabetic retinopathy, diabetic kidney disease, and peripheral neuropathy, while D-dimer and coagulation factor XI were associated with cardiovascular outcomes. These findings suggested potential interactions among coagulation activation, impaired fibrinolysis, and diabetes-related vascular injury. Nevertheless, the predominance of cross-sectional studies limited causal inference. Hemostatic biomarkers may complement individualized risk assessment for diabetes-related complications; however, the available evidence does not support routine coagulation testing in all patients with T2DM. Further prospective, multicenter studies employing standardized diagnostic criteria and laboratory measurements are needed to establish the predictive validity and clinical utility of these biomarkers across diverse patient populations.