Diabetic Platelets: Pathophysiology, Clinical Significance, and Therapeutic Perspectives

Platelets are crucial for haemostasis and thrombosis. They acquire a distinct prothrombotic and proinflammatory platelet phenotype in individuals with diabetes mellitus, particularly type 2 diabetes mellitus (T2DM). Such platelets in people with diabetes (diabetic platelets) contribute to the pathogenesis of micro- and macro-vascular complications in T2DM. Chronic hyperglycaemia, oxidative stress, advanced glycation end-products (AGEs) and insulin resistance converge to reprogram platelet function at the molecular level. This results in platelet hyperreactivity, enhanced aggregation and a diminished therapeutic response to standard antiplatelet medications. Platelets in people with diabetes play a central role in the development and progression of cardiovascular disease (CVD), the most common cause of mortality in such patients. This manuscript explores the structural and functional changes in platelets in people with diabetes, underlying molecular mechanisms, their role in vascular complications and therapeutic perspectives in patients with diabetes. Also, we introduce the concept of 'haematobolomics' to drive more research in the metabolic profile of platelets in people with diabetes, being a potential avenue for personalised therapeutics.