Aim To evaluate the relationship between the concentration of plasma retinol-binding protein 4 (RBP4) and subclinical atherosclerosis (subAs) in newly diagnosed type 2 diabetes mellitus (T2DM) patients. Methods 217 newly diagnosed T2DM patients were selected. Plasma RBP4 concentration, fasting and postprandial blood glucose, glycosylated hemoglobin A1 (HbA1c), blood lipid, fasting insulin (FINS) and common carotid artery intima-media thickness (IMT), common iliac artery IMT, femoral artery IMT were measured. The occurrence of subAs in patients was analyzed. Results The average age, FINS and plasma RBP4 concentration in T2DM patients with subAs were significantly higher than T2DM patients with non-subAs (all P＜0.05). The patients were divided into three groups based on the concentrations of RBP4. With the increase of RBP4 concentration, the common carotid artery IMT, common iliac artery IMT, femoral artery IMT were increased, and the common carotid artery IMT in high concentration RBP4 group was higher than that in the other two groups (P＜0.05). With the increase of RBP4 concentration, the prevalence of subAs was gradually increased, and the prevalence of subAs in high concentration RBP4 group was significantly higher than that in the other two groups (P＜0.05). Correlation analysis showed that the RBP4 concentration of newly diagnosed T2DM patients was positively correlated with common carotid artery IMT, common iliac artery IMT, body mass index, systolic blood pressure, blood glucose and FINS. Multiple stepwise Logistic regression analysis showed that the incidence of subAs in newly diagnosed T2DM patients was significantly correlated with the levels of plasma RBP4, age, and low density lipoprotein cholesterol. Conclusion Plasma RBP4 level is positively correlated with subAs, and plasma RBP4 elevation may be one of the independent risk factors of subAs in newly diagnosed T2DM patients.