Vascular oscillation (vasomotion) occurs in the microcirculation and is thought to be a significant contributor to tissue perfusion. Our aims were to assess the relationship of vasomotion to perfusion in the cutaneous microcirculation of diabetic patients, to determine the influence on it of endothelium dependent and non-endothelium dependent vasodilatory stimuli and to assess the relationship to perfusion and vasomotion of various biochemical markers of vascular function (HbA1c, LDL and HDL-cholesterol, triglycerides, insulin resistance, hsCRP, L and E-selectin, soluble ICAM, von Willebrand Factor) and microalbuminuria. Perfusion and vasomotion (spectral density at low and very low frequencies) were measured using laser Doppler flowmetry after local heat and iontophoresis of acetylcholine and sodium nitroprusside. Perfusion responses to all stimuli were impaired in type 2 diabetes (heat F=28.0, p<0.001; AcCho F=7.11, p=0.003; SNP F=4.0, p=0.028) . Responses to endothelium dependent stimuli were further impaired in microalbuminuric patients (heat p=0.035; Ach p=0.034). Vasomotion responses at low frequencies following endothelium dependent stimuli were impaired in diabetic patients compared with controls (heat F=5.62, p=0.002; Ach F=4.32, p=0.015). Multivariate modelling showed microalbuminuria to be the only consistent predictor of perfusion and vasomotion responses. The results suggest that microalbuminuria in type 2 diabetes reflects a generalized disturbance of microvascular function related to endothelium dependent mechanisms.