Microalbuminuria (MA) is an independent risk factor for atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Postprandial lipemia is also associated with excess cardiovascular risk. However, the association between MA and postprandial lipemia in diabetes has not been investigated. A total of 64 patients with T2DM, 30 with and 34 without MA were examined. Plasma total triglycerides (TG), TG contained in chylomicrons (CM-TG), and in chylomicron-deficient plasma were measured at baseline and every 2 hours for 6 hours after a mixed meal. Post-heparin lipoprotein lipase (LPL) and hepatic lipase (HL) activity were also determined. Plasma levels of apolipoprotein (apo)A-V, C-II, and C-III were measured in the fasting state and 2 hours postprandially. Patients with MA had higher postprandial total TG levels than those without MA (P < 0.001), the increase been attributed mainly to CM-TG. LPL activity and fasting concentrations of the measured apolipoproteins were not different between the studied groups, while HL activity was higher in the patients with MA. ApoC-II and apoC-III levels did not change postprandially in either study group, while apoA-V increased more in the patients with MA. These data demonstrate for the first time that MA is characterized by increased postprandial lipemia in patients with T2DM and may explain in part the excess cardiovascular risk in these patients.