<![CDATA[Type 2 diabetes mellitus can alter complete blood count parameters and peripheral blood morphology through chronic hyperglycemia, inflammation, oxidative stress, and endothelial dysfunction, changes that may support clinical monitoring and risk stratification. This systematic review synthesized current evidence on these hematological alterations in adults with type 2 diabetes mellitus. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, four databases were searched for studies published between January 2020 and December 2025, and findings from twenty eligible studies were narratively synthesized due to substantial heterogeneity. Most studies reported reduced hemoglobin, hematocrit, red blood cell count, and red blood cell indices, alongside consistently elevated red cell distribution width, particularly in patients with poor glycemic control or complications. Increased white blood cell count, neutrophil-to-lymphocyte ratio, mean platelet volume, and platelet distribution width reflected inflammation and platelet activation, while peripheral smears frequently showed anisocytosis, poikilocytosis, echinocytes, and spherocytes. These parameters are consistently associated with type 2 diabetes mellitus, but the predominance of observational studies limits causal and prognostic interpretation, highlighting the need for prospective studies to establish their clinical utility.]]>
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