There is an increasing need to identify novel biomarkers of DM complications particularly in view of potential applications in precision medicine . Available data suggest that circulating both HSP and anti - HSP levels may be exploited as biomarkers of diabetic vascular diseases ( Table 3 ) ; however , studies performed in this area have important limits . They are often conducted on small groups of patients and without adjustment for conventional risk factors and confounders . Sometimes patients with diabetic complications are compared with healthy subjects , not taking into account that DM itself can affect HSP circulating levels . Finally , there are insufficient prospective studies assessing the importance of HSPs / anti - HSPs in predicting outcomes and guiding intervention . Therefore , it would important in the future not only to identify independent associations between HSPs / anti - HSPs and DM complications in large cohorts of well - characterised patients with DM , but also to prospectively validate promising biomarkers for future applications in clinical practise .  