The pathogenesis of diabetic micro- and macroangiopathy cannot be fully explained by hyperglycemia alone. To clarify diabetic complications mediated by increased platelet activity, we have studied platelet aggregation and its second messenger molecules such as protein kinase C (PKC), RhoA, and phosphatidylinositol 3-kinase (PI3- kinase), in six diabetic patients with diabetic retinopathy and other diabetic complications in spite of good glycemic control. Their HbA(1c) levels throughout the observation period had been less than 6% with diet treatment alone, despite which diabetic retinopathy developed to the pre-proliferative stage during 2-8 years observation. Low-dose thrombin (< 0.5 U/ml)-stimulated platelet aggregation in the diabetic patients was enormously elevated compared with healthy control subjects. PKC, RhoA and PI3-kinase activities in the cytosol- and membrane-associated fractions were examined in the platelets from the two patients (Cases 2 and 4). Platelet membrane-associated RhoA and PI3-kinase activity in Case 2 were increased before the stimulation. Platelet RhoA and PI 3-kinase activities in Case 4 were increased after the stimulation with low-dose thrombin (0.01 U/ml). Membrane-associated immunoreactive PKC alpha, but not PKC beta in Cases 2 and 4 was elevated. Although platelet hyperactivity in these four patients was observed, PKC and RhoA in mononuclear leukocytes from these patients were not different from healthy subjects. Membrane-associated PKC alpha and RhoA immunoreactivities also increased in the other three cases. These results suggest that hyperreactivity of PKC alpha may lead to increased RhoA and PI3-kinase activities and platelet hyperfunction in diabetic patients with good glycemic control, and that raised platelet PKC alpha may be implicated in the pathogenesis of diabetic complications.