Platelets are thought to be involved in the pathogenesis of diabetic retinopathy. The BglII gene polymorphism of the 21 integrin, which is a platelet collagen receptor, has been suggested as a genetic risk factor for diabetic retinopathy in Japanese subjects. The aim of this study was to look for a relationship between the BglII gene polymorphism of the 21 integrin gene and the development of diabetic retinopathy in Caucasians with type 2 diabetes. Subjects with type 2 diabetes and diabetic retinopathy (n=163) were compared with diabetic subjects without diabetic retinopathy (n=95). A significantly higher frequency of the BglII (+/+) genotype of the gene polymorphism of the 21 integrin gene was found in patients with diabetic retinopathy compared with patients without diabetic retinopathy (19.6% vs 7.4%; P=0.008). The present study demonstrates that the BglII (+/+) genotype of the gene polymorphism of the 21 integrin gene is an independent risk factor (odds ratio: 2.4, 95% confidence interval 1.0–6.0; P<0.05) for diabetic retinopathy in Caucasians with type 2 diabetes.