We evaluated the relationship between serum mannose-binding lectin (MBL) and mortality and incident albuminuria in 326 patients with type 2 diabetes mellitus (T2DM). During 15 years of follow-up, 169 patients died. In a multivariate analysis, MBL was a significant risk factor for death from any cause and added to the predictive power of CRP. Normoalbuminuric patients with both high MBL and high C-reactive protein (CRP) levels had a significantly increased risk of developing albuminuria. We conclude that MBL alone or in combination with CRP can provide prognostic information on mortality and the development of albuminuria in T2DM