Considering the magnitude of increased post-transcriptional α2-macroglobulin synthesis in the liver in response to urinary protein excretion54–56, it is reasonable to assume that circulating α2-macroglobulin levels may be increased far more profoundly by urinary albumin than by other factors such as sex, age, glycemic control or diabetic retinopathy. This evidence concerns the gene ALB and diabetic retinopathy.