APN is a cytokine secreted by adipocytes and binds to its receptors to regulate lipid/glucose metabolism and anti-inflammatory effects.[28] Previous research has shown that the level of APN is associated with the DR status in various ethnic groups.[12,14] In the present study, the APN level was an independent risk factor for DR after adjusting for age, DM duration, HbA1c, and SBP, which are the potential confounding factors. Here, ANPEP is linked to diabetes mellitus.