The soluble form of the vascular cell adhesion molecule‐1 (VCAM‐1) is detectable in human sera and is elevated in diabetic patients, with unknown clinical significance. In the present study, the relationship between serum soluble VCAM‐1 and diabetic microvascular complications (retinopathy, nephropathy, and neuropathy) was evaluated in 95 Japanese patients with Type 2 diabetes mellitus (DM). Serum soluble VCAM‐1 concentration was higher in patients with more advanced stages of retinopathy as well as nephropathy. There was a significant correlation between soluble VCAM‐1 and log₁₀ (urinary albumin excretion) in 69 patients with normal serum creatinine levels (r = 0.51, p<0.0001) and a significant correlation between soluble VCAM‐1 and log₁₀ (serum creatinine) in all the patients (r = 0.83, p<0.0001). Soluble VCAM‐1 concentration was also elevated in patients with neuropathy. There was a significant correlation between soluble VCAM‐1 concentration and the number of microvascular complications (r = 0.59, p<0.0001). However, multivariate regression analysis revealed that only diabetic nephropathy, was associated with the soluble VCAM‐1 concentration. The elevation of circulating VCAM‐1 level in diabetic nephropathy may result from underlying systemic endothelial dysfunction, increased VCAM‐1 production in damaged renal tubular or glomerular epithelial cells and/or decreased renal clearance of this molecule, depending on the stage of nephropathy. © 1998 John Wiley & Sons, Ltd.