Introduction:
Type 2 diabetes mellitus (T2DM) is a prevalent and progressive metabolic disorder marked by chronic hyperglycemia and associated with significant vascular complications. While insulin resistance and β cell dysfunction remain central to its pathogenesis, recent attention has turned to the role of blood rheology in the disease. Abnormalities in hemorheological parameters are increasingly recognized as contributors to microvascular dysfunction in diabetes, exacerbating tissue hypoxia and potentially accelerating the progression of diabetic complications. The purpose of this review is to summarize the current knowledge on the rheological disturbances observed in T2DM, with a focus on their pathophysiological basis, clinical relevance, and potential as therapeutic targets.

State of knowledge:
Hemorheological disturbances play a crucial role in the vascular pathology of T2DM. These changes impair microcirculation, promote tissue hypoxia, and increase vascular resistance, contributing to vascular complications such as retinopathy, nephropathy, stroke, and ischemic heart disease. Growing evidence also highlights the role of plasma proteins (e.g., AGER or HSP) and oxidative stress in modulating blood rheology. Hemorheological parameters are thus gaining importance not only as diagnostic indicators, but also as therapeutic targets. In addition to glycemic control, increasing emphasis is placed on interventions that improve blood rheology, including statins to reduce fibrinogen levels and pentoxifylline to enhance erythrocyte deformability and reduce viscosity.

Conclusions:
Increased plasma viscosity, increased fibrinogen levels, red blood cell aggregation, and decreased erythrocyte deformability are the most important rheological parameters that are worth monitoring. Maintaining optimal levels of glycemia and lipids, as well as drugs such as statins and pentoxifylline, improve blood rheology, reducing the risk of vascular complications.