Common Carotid artery (CCA) intima-media thickness (IMT) has been shown to reflect histopathologically verified atherosclerosis and therefore is widely used to detect and quantify non-invasive measurements of atherosclerosis. The present study aimed to investigate the CCA IMT in elderly patients with non-insulin dependent diabetes mellitus (NIDDM) as a predictor of early atherosclerosis and its correlation to the development of diabetic complications.CCA IMT was measured by high resolution ultrasound in a total of 50 elderly subjects; 40 patients with type 2 diabetes and 10 healthy control subjects. Patients were classified into two groups, group 1a with known micro or macrovascular complications and group 1b without clinical or laboratory evidence of micro or macrovascular complications.CCA IMT was increased in diabetic patients compared with the control (P = 0.001). Also, IMT was increased in diabetic patients with micro or macrovascular complications compared to non-complicated diabetics (P= 0.001). CCA IMT was significantly positively correlated with age, duration of diabetes, fasting and postprandial blood sugar, total cholesterol, triglycerides, LDL- cholesterol, 24 hours- urinary proteins (r = 0.36, 0.57, 0.58, 0.52, 0.66, 0.74, 0.79, 0.66, respectively) and negatively correlated to HDL- cholesterol (r = - 0.36). The study showed that diabetic patients with coronary artery disease had significant increase of CCA IMT (P = 0.001). Moreover, IMT was significantly positively correlated with the number of complications whether micro or macrovascular complications (P=0.001). Conclusion: CCA IMT is an early noninvasive, reproducible and sensitive marker for subclinical atherosclerosis in diabetic patients that can help and add in early detection of such a famous process in diabetics before the development of gross complications with its gross morbidity and mortality.