Abstract
There is no direct and conclusive evidence that genetic factors play a role in the pathogenesis of microangiopathy in diabetes. Associations between HLA antigens and complications, which would contribute conclusive evidence of a genetic contribution to the genesis of these complications, have been reported but not consistently confirmed. On the other hand, circumstantial evidence from studies of the natural history of the disease and its complications and from twin studies strongly suggest that genes do contribute to the susceptibility to small vessel disease. The most important genes providing this susceptibility are probably unrelated to HLA. Even if the total genetic contribution to susceptibility for microangiopathy turns out to be small in comparison with that provided by metabolic factors, their knowledge early in the course of the disease would serve the important role of identifying subjects in need of more intensive diabetic management to prevent vascular complications.
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