To clarify the risk factors for developing microalbuminuria in patients with type 2 diabetes mellitus, a longitudinal observational study was performed. Fifty patients with normoalbuminuria were recruited and treated conventionally for 9 years. Polymorphisms of the angiotensin-converting enzyme (ACE) gene and the angiotensinogen M235T polymorphism were examined. During the study period, 12 of the 50 patients developed microalbuminuria; no patients progressed to macroalbuminuria. Multiple logistic regression analysis was performed using age, duration of diabetes, body mass index, haemoglobin A1c' blood pressure, serum lipid profile and genetic polymorphisms as independent variables and development of microalbuminuria as the dependent variable. The D allele of the ACE gene was an independent and significant variable. We conclude that the ACE gene D allele polymorphism is a potent risk factor for developing microalbuminuria in type 2 diabetic patients.