Background: Cardiovascular diseases (CVDs) are the primary cause of mortality worldwide with 17.3 million deaths per year and an estimation of 23.6 million in 2030, placing it as a relevant issue for the public health system. Objectives: This study aimed to assess the Remodeling Index (RI) and its relation to coronary heart disease in patient with type 2 diabetes mellitus (T2DM) by multi-slice coronary CT angiography (MSCTA). Patients and methods: This prospective observational study was conducted in Cardiology Department and Radiology Department in El-Agouza, Academy, Nasr City Police Hospital. The study included 250 patients with coronary remodeling of which 200 patients with type 2 diabetes (group I) and 50 are non-diabetics (group II) matched in age and sex with the patients' group I (P > 0.05). All patients referred for MSCT coronary angiography. Results: As regard remodeling index of the two groups were 1.11 ± 0.34 and 0.81 ± 0.29 in groups (I) and (II), respectively. They showed a statistically highly significant difference between the two groups (p < 0.001). The level of < 75th percentile was found in 74% and 100% of patients in groups (I) & (II), respectively, while level of >75th percentile was found in 26% of group (I) and not found in group (II) and they showed a statistically very highly significant difference (p < 0.001). Conclusion: Patients with T2DM are susceptible to premature CAD with more calcified and non-calcified plaques. Early prevention program using computed tomography angiography might be helpful in identifying diabetic patients with subclinical atherosclerosis.