Background: Type 2 Diabetes Mellitus (T2DM) is a significant global health burden, associated with a hypercoagulable state due to persistent hyperglycemia, platelet hypersensitivity, and impaired fibrinolysis. Alterations in coagulation parameters, particularly shortened Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT), indicate an increased thrombotic risk. This systematic review and meta-analysis aimed to assess the impact of poor glycemic control on coagulation dysfunction in T2DM patients. Methods: Following PRISMA guidelines (INPLASY202350096), a systematic search was conducted in PubMed for case-control studies evaluating PT and APTT in T2DM patients and healthy controls. Studies published between 2014 and 2024 were included, and a random-effects model was used to estimate pooled mean differences. Heterogeneity was assessed using I² statistics, with subgroup and sensitivity analyses conducted to explore potential sources of variability. Results: Sixteen case-control studies, including 1,951 participants (978 controls, 973 T2DM patients), were analyzed. Pooled results showed a significant reduction in PT (MD: -1.92 seconds, 95% CI: -2.34 to -1.50, p < 0.001, I² = 62%) and APTT (MD: -6.04 seconds, 95% CI: -7.22 to -4.86, p < 0.001, I² = 78%) in T2DM patients. Subgroup analysis indicated greater reductions in smaller studies (<100 participants) and recent publications (2020-2024). Sensitivity analysis confirmed result robustness, while funnel plots suggested minimal publication bias (Egger’s p = 0.12 for PT, p = 0.04 for APTT). Higher HbA1c levels (>8%) correlated with greater PT and APTT reductions, emphasizing the link between poor glycemic control and prothrombotic risk. Conclusion: T2DM is associated with significantly shortened PT and APTT, reflecting a hypercoagulable state that increases thrombotic risk. Routine coagulation screening in poorly controlled T2DM patients (HbA1c ≥ 8%) may help identify high-risk individuals for preventive anticoagulant therapy. Future studies should standardize coagulation assays and assess the impact of glycemic control on coagulation abnormalities.