Background: Diabetic nephropathy is a clinical syndrome characterized by a set of structural and functional kidney abnormalities in patients with diabetes mellitus and is the leading cause of end stage renal failure. Objective: This study aimed to evaluate VCAM-1 as a marker of microvascular dysfunction in patients with diabetic nephropathy. Methods: The present study was conducted through the duration between December 2022 and July 2023. The patients were selected from Diabetes and the Nephrology Outpatient Clinics and inpatients of the Internal Medicine Department, at Menoufia University Hospitals. This study included 36 diabetic patients divided into 3 groups according to urinary albumin excretion: Group 1 included 15 diabetic patients with normoalbuminuria, group 2 included 11 diabetic patients with microalbuminuria and group 3 included 10 diabetic patients with macroalbuminuria. In addition to fourteen apparent healthy subjects as a control group. Results: The mean VCAM-1 levels were higher in diabetics compared to controls. There was a highly significant difference between the three diabetic subgroups as regards serum VCAM-l. There was a highly positive correlation between VCAM-1 and serum creatinine. Also, there was a highly significant positive correlation between VCAM-1and urinary albumin excretion in whole diabetic patients as well as patients with diabetic nephropathy. Receiver operating characteristic (Roc) graph revealed that the best cut off of serum VCAM-1 to differentiate between diabetics and control subjects was 646.5ng/ml as the diagnostic sensitivity was 80.6%, specificity was 64.3%, and diagnostic accuracy was 76%. The area under the ROC curve was 0.789. The best cut off of serum VCAM-1to detect diabetic nephropathy was 792.5 ng/ml as the diagnostic sensitivity was 100 %, specificity was 80%, and diagnostic accuracy was 91.7%. The area under the Roc curve was 0.917. Conclusion: VCAM-1 could potentially serve as a marker for diabetic nephropathy.