Abstract Background: In patients with diabetes mellitus (DM), compared with those without DM, (CAD) tends to be more diffuse, complex, and associated with increased morbidity and mortality from cardiovascular disease. The SYNTAX score (SS) uses coronary anatomy to objectively guide deci-sions regarding mode of revascularization. It characterizes the extent of coronary disease in terms of the number of lesions, their functional importance, and their complexity, while GENSINI Score accounts for the degree of artery disease in diabetic patients. Aim of Study: The aim of this study was to assess the correlation between fructosamine level and the severity of CAD by calculating SYNTAX and GENSINI scores in diabetic patients presenting to Ain Shams University Hospital with symptomatic chronic coronary syndrome undergoing elective coronary angiography. Patient and Methods: This study was conducted on 200 diabetic patients with chronic coronary syndrome undergoing elective coronary angiography, with mean age 54.36±5.86 years ranging from 32 years to 65 years. The majority of them were males (64%). Results: Atotal of 200 diabetic patients were included in the study. Mean ± SD age was 54.36±5.86 years. Of the total 64% (128) were males, 74% (149) were hypertensive and 57% (113) were smokers.We found that higher fructosamine level was strongly correlated with disease severity and higher SYNTAXas well as GENSINI score as fructosamine and SYNTAX score (r=0.668) and with GENSINI (r=0.734) (p-values <0.001 and <0.001 respectively). A significant increase in fructosamine level was notedin higher tertiles of SYNTAX and GENSINI scores (p-values <0.001 and <0.001 respective-ly). There was also a positive correlation between both HbA1c and SYNTAX score (r=0.636) and with GENSINI score (r=0.716). Conclusion: There was a significant correlation between serum fructosamine level and severity of CAD assessed by the angiographically derived SYNTAX and GENSINI scores and fructosamine may have a value as a predictor of severity of CAD and risk stratification of diabetic patients as patients with a higher level of fructosamine had significant severe lesions where higher SYNTAX (third tertile >32) and Gensini (third tertile >38). In addition to that a strong positive corre-lation was found between markers of glycemic variability fructosamine and HbA1c.