The Paradox of War and Diabetes: Prolonged Prothrombin Time, Shortened APTT, and Platelet Activation in Yemeni Patients with Type 2 Diabetes Mellitus

Background Type 2 diabetes mellitus (T2DM) induces a hypercoagulable state, increasing thrombotic risk. However, data characterizing hemostatic abnormalities in T2DM patients from conflict zones with crippled healthcare systems, like Yemen, are profoundly scarce. The interplay between type 2 diabetes mellitus (T2DM) and hemostasis in conflict settings with widespread malnutrition remains unexplored. Objectives This study aimed to evaluate coagulation parameters and platelet indices among Yemeni adults with T2DM and to correlate these hemostatic markers with the degree of glycemic control. Methods A hospital-based cross-sectional study was conducted on 140 T2DM patients and 100 healthy controls in Aden, Yemen. Prothrombin time (PT), activated partial thromboplastin time (APTT), mean platelet volume (MPV), and platelet distribution width (PDW) were measured using standardized analyzers (STA-R Evolution and Sysmex XN-550). Glycemic control was assessed via HbA1c. Results A significant majority (86%) of patients had poor glycemic control (HbA1c ≥ 7%). T2DM patients exhibited a distinct coagulation profile characterized by prolonged PT (13.4 ± 1.8 vs. 12.1 ± 1.2 sec, p < 0.01) and shortened APTT (32.5 ± 4.1 vs. 35.2 ± 3.5 sec, p = 0.02) compared to controls. Platelet indices were markedly elevated, with higher MPV (10.2 ± 1.5 vs. 8.7 ± 1.1 fL, p < 0.001) and PDW (16.8 ± 2.1 vs. 15.2 ± 1.8%, p = 0.01). A strong positive correlation was observed between HbA1c and MPV (r = 0.52, p < 0.001). Conclusion These findings advocate for the urgent integration of affordable coagulation (PT/APTT) and platelet indices screening into diabetic care protocols in conflict-affected and low-resource settings to guide targeted nutritional and anti-thrombotic interventions.