Association between Sex and Platelet Function in Patients with Diabetes Mellitus Type II: A Systematic Review

Type 2 diabetes mellitus (T2DM) is associated with a significant risk for development of cardiovascular diseases (CVD), in which platelets play a pivotal role. Sex-related differences in CVD exist in terms of prevalence, risk factors, clinical presentation, treatment, outcomes, and prognosis. Platelet activation may contribute to these sex-related differences. The aim of this systematic review was to investigate whether platelet function differs between men and women with T2DM. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature searches in PubMed and Embase were performed. We included studies that investigated differences in platelet function parameters, platelet indices, or platelet transcriptomics in patients with T2DM. The risk of bias was assessed according to the National Heart, Lung and Blood Institute. Twenty-six studies were included. No significant differences in platelet activation between men and women with T2DM were consistently reported in the literature, although 7 of the 26 studies found significantly altered platelet indices, higher platelet aggregation, higher P-selectin expression, or higher prevalence of acetylsalicylic acid resistance in women. Two studies reported a significantly higher platelet aggregation in men. None of the included studies investigated the association between sex and platelet function as a primary outcome. A wide range of platelet function methods were employed, which caused considerable heterogeneity and challenged the comparison across the studies. Due to the limited amount of evidence on this topic, further studies are needed to provide insight into sex differences in platelet function in patients with T2DM.