Background: Lactobacillus acidophilus is a probiotic strain that is widely used in traditional foods such as dairy products and nutritional supplements. It has been shown that L. acidophilus interacts with immune system cells and increases intestinal integrity with a beneficial effect on glucose balance as it has been found to delay the onset of glucose intolerance, hyperglycemia, dyslipidemia and oxidative stress in diet-induced diabetic rats. Objectives: To assess the level of TNF alpha in type 2 diabetic patients with lactobacillus acidophilus. Patients and methods: This study is a case control study that was conducted on 100 type 2 diabetic patients diagnosed according to the American diabetes association diagnostic criteria. They were recruited from the Outpatient Clinic of Internal Medicine and Endocrinology Department Unit of Ain Shams University Hospitals during the period from February 2019 to November 2019. They were divided into 2 groups, group 1 that included 50 type 2 diabetic patients with atherosclerosis and group 2, which included 50 type 2 diabetic patients without atherosclerosis. Results: There was a statistically significant positive correlation between PCR cut-off threshold and HbA1c (p-value = 0.026), 2hr pp (p-value = 0.013) and intimal media thickness (p-value = 0.031) and there was a statistically significant positive correlation between TNF alpha level and HbA1c (p-value = 0.015), LDL cholesterol (p-value = 0.024) and intimal media thickness (IMT) (p-value = 0.033). In addition, there was highly statistically significant positive relation found between TNF alpha level and PCR cut-off threshold (p-value < 0.001). Conclusions: Lactobacillus acidophilus has been found to delay the onset of glucose intolerance, hyperglycemia, dyslipidemia and oxidative stress in patients with type 2 diabetes mellitus.