The Diabetic Platelet

Review Article

J Fam Med. 2022; 9(6): 1312.

The “Diabetic Platelet”

Neokleous N*, Mpountola S and Perifanis V

Department of Properatory Internal Medicine, AHEPA, Aristotle University School of Medicine, Thessaloniki, Greece

*Corresponding author: Nikolaos Neokleous, Department of Properatory Internal Medicine, AHEPA, Aristotle University School of Medicine, Thessaloniki, Greece

Received: July 14, 2022; Accepted: September 08, 2022; Published: September 15, 2022


Patients with Diabetes Mellitus (DM) have accelerated atherosclerosis, which is the main essential factor contributing to the high risk of atherothrombotic events in these patients. Atherothrombotic complications are the principal cause of morbidity and mortality in patients with DM. Both atherosclerosis and the increased risk of thrombotic vascular events may result from dyslipidaemia, endothelial dysfunction, platelet hyperreactivity, an impaired fibrinolytic balance, and abnormal blood flow. Platelets of DM patients are characterised by dysregulation of several signalling pathways causing increased adhesion, activation and aggregation. Platelet function of patients with DM is complicated by several mechanisms, such as hyperglycaemia, insulin deficiency and resistance, associated metabolic conditions, and cellular abnormalities. The present manuscript purposes to provide a review on the up-to-date status of data on platelet abnormalities that characterise patients with DM.


The most important factor that contributes to the increased risk of atherothrombotic events in patients with Diabetes Mellitus (DM) is accelerated atherosclerosis. Cardiovascular disease, mainly Coronary Artery Disease (CAD), including Acute Coronary Syndrome (ACS), is the first cause of morbidity and mortality in these patients [1]. It is reported 20 years ago that DM patients without any history of CAD have the same cardiac mortality risk as non-DM patients with a history of Myocardial Infarction (MI) [2]. Furthermore, cardiovascular disease has equally poor prognosis in patients with DM as they have a higher risk of complications and recurrent atherothrombotic events than non-DM patients [3]. In fact, in an ACS scenario, DM is a strong independent predictor ischemic events recurrence, including mortality [4]. After all, the presence of comorbidities that have negative impact on ACS outcomes is higher in DM patients [5]. Several factors are involved to the prothrombotic condition of patients with DM, such as the following: increased coagulation, impaired fibrinolysis, endothelial dysfunction and platelet hyper reactivity [6,7]. The latter is of specific importance, since platelets play a pivotal role in the formation, development and sustainment of thrombi [8]. Platelets of patients with DM are characterised by dysregulation of several signalling pathways, and they are hyper reactive with intensified adhesion, activation and aggregation [6,9-12]. Such a hyperreactive platelet may result to the higher part of DM patients with insufficient response to anti platelet agents compared with non-DM subjects [13,14]. Several metabolic and cellular abnormalities provoke multiple mechanisms that play a role in the increased platelet reactivity observed in patients with DM. These mechanisms can be joined into the following aetiopathogenic categories [15]: a) hyperglycaemia, b) insulin deficiency and resistance, c) associated metabolic conditions, and d) other cellular abnormalities (Table 1).