In Reply We thank Antonopoulos et al for their letter and in particular for highlighting the importance of microvascular complications in patients with diabetes. Risk stratification remains challenging in patients with type 2 diabetes because of the complex interplay between underlying pathologic processes. Microvascular disease (eg, nephropathy, retinopathy, and neuropathy) is both a complication of diabetes and a well-established risk factor for future complications, including renal failure, heart failure, and death.^1,2

In the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) population, we have reported the association between baseline estimated glomerular filtration rate and outcomes³ as well as the effect of saxagliptin vs placebo on urinary albumin excretion.^4,5 To better understand the associations between biomarkers, renal disease, and outcomes, we are currently investigating the ability of biomarkers, such as N-terminal pro–B-type natriuretic peptide, high-sensitivity troponin T, or high-sensitivity C-reactive protein, to predict microvascular complications (eg, increased urinary albumin excretion or renal failure), as well as the prognostic value of urinary albumin levels when combined with established cardiovascular biomarkers.