## 2 Topics and Results
### Recent Advances in Modeling Diabetic Blood Platelets
#### 2.6.2 Potential Platelet Biomarkers Related to T2 DM  
Altered structure and architecture, as well as fibrin clot functions, have been reported in patients with DM2, as well as in cases of coronary artery disease (CAD). DM2 unfavorably affects plasma fibrin by lowering its permeability and susceptibility to lysis while simultaneously increasing fibrinogen plasma levels, leading to hyperfibrinogenemia. Specifically, these changes are attributed to fibrinogen and fibrin glycation in diabetic patients. Platelet activation in DM2 is a well-known modifier of fibrin clot properties. In the presence of activated PLTs, fibrin clots have a specific architecture with local increases in fibrin fiber diameter and density [13]. P-selectin, expressed in alpha-granules of activated platelets in DM2 patients, also increases. The role of vWF in altering plasma fibrin network properties remains to be established, which is closely related to fibrinolysis/thrombolysis [9]. Dynamic changes in platelet shape and morphology progress from an \"active\" to a \"procoagulant state\" [48; 49]. Correlations were found between MPV as a main biomarker of PLT activation and metabolic status in type 2 diabetes patients [14; 21; 25; 50; 51; 52]. Important hemogram parameters are MPV, platelet count (PLT), PDW, PCT, HbA1c, and disease duration. Some authors have suggested that RDW is also an important predictor of vascular complications in DM2 [33]. Prospective studies are needed to define and clarify the relationships between hematologic/hematometric indices. MPV and PDW can be easily determined by routine automated hemograms, and these parameters are significantly elevated in diabetic patients compared to healthy individuals. Among diabetic patients, MPV and PDW meansare higher in patients with complications (not statistically significant) [25]. Researchers have suggested that monitoring DM2 and, thus, preventing vascular complications, is needed. PDW is also a main PLT index that is significantly higher in diabetic patients than in healthy controls. PLT indices are useful biomarkers for vascular risks in grading DM. These findings suggest that increased PLT activation plays a role in the pathogenesis of DM vascular complications. Additionally, regular glycemic control improves platelets' biological activities and functions. Thus, good glycemic control helps in DM2 treatment and management, potentially delaying micro- and macrovascular complications attributable to DM2 as a socially significant disease. Vascular complications appearing in DM2's prothrombotic/thrombotic state are mainly related to risk factors for clot formation. At this DM2 stage, the presence of larger PLTs, as well as \"giant platelets\" in patients' blood smears, may provide simple, effortless, and cost-effective diagnostic/prognostic tools for predicting the thrombotic state in DM2 development and other pathological states. Platelet activation plays an important role in the development of vascular DM2 complications. MPV and PDW pathological levels also increase as precise biomarkers of platelet activation in DM. In their prospective study, [PERSON] et al. found a statistically significant correlation between MPV and HbA1c values [50]. In 1979, [PERSON] et al. were the first to show that PLTs have insulin receptors, with a density of about 500 receptors/thrombocyte [52; 53]. In this way, insulin regulates PLT functions directly and has an inhibitory effect on platelet hyperactivity. Recent studies [54] provide insight into the potential role of platelet hematological/hematometrical parameters (PLT count, MPV, and PDW) as biomarkers in the diagnosis, management, and prognosis of DM2. These simple DM2 biomarkers may play an important role in routine medical practice [52; 55]. At present, mean platelet volume (MPV) is a commonly used marker of PLT size and biological activity. Larger PLTs have increased pro-thrombotic potential compared to smaller ones. In addition to routine clinical practice, SEM and AFM microscopies confirm this conclusion [9; 13; 14].