Chen et al. observed that binding sites for the transcription factor Sp1 regulate hyperglycaemia-induced activation of the PAI-1 promoter in vascular smooth muscle cells which suggests that covalent modification of Sp1 by N-acetylglucosamine (GlcNAc) might explain the link between activation of the hexosamine pathway and hyperglycaemia-induced changes in transcription of the gene for PAI-1 [57]. This evidence concerns the gene SERPINE1 and Hyperglycemia.