Background: The incidence of microvascular complications is rising although there is improvement in glycemic control, dyslipidemia, and hypertension treatment. Early identification of patients with a high risk of developing vascular complications helps in their prevention. There is a strong need for biomarkers for use in the early detection of microvascular complications. Ischemia-modified albumin (IMA) is formed when ischemia of the hypoxic tissue induces modification of circulating albumin. IMA is a sensitive marker of tissue hypoxia and oxidative stress.
Objectives: to evaluate the relationship of IMA to glycemic state and its ability to predict microvascular complications of diabetic neuropathy (DN) and diabetic retinopathy (DR) in type 2 DM patients. 
Patients and methods:100 Participants were divided into three groups:
Group A: (n=35) complicated type 2 diabetic patients (with neuropathy, retinopathy, or both). GroupB: (n=35) non-complicated type 2 diabetic patients, GroupC: (n=30) control group (healthy individuals).
Results: Using the ROC curve of IMA in predicting diabetic neuropathy and retinopathy, showed high sensitivity, the area under the curve (AUC) is 0.948 (95% CI 0.885:0.983), p <0.0001, cutoff point>95.7 U/ml (sensitivity =100%, specificity =95.7%, PPV =74.3%, and NPP =100%), ROC curve of IMA in predicting diabetic retinopathy the AUC is 0.960  (95% CI 0.900:0.989), p <0.0001, cutoff point>110.5 U/ml (sensitivity =100%, specificity =94.4%, PPV =87.9%, and NPP=100%).
Conclusion: Ischemia-modified albumin levels were significantly higher in patients with DN and DR.