Aim To investigate the relationship of serum adiponectin and atherosclerosis(As) in type 2 diabetic patients (T2DM). Methods 90 patients of ischemic cerebrovascular disease were divided into type 2 diabetes group (47 cases) and non-diabetic group (43 cases) according to diagnostic criteria of T2DM and carotid artery lesions. Type 2 diabetes group's patients were divided into mild stenosis group (12 cases),moderate stenosis group (27 cases) and severe stenosis group (8 cases). The extent of coronary artery stenosis was evaluated by cerebral angiography,the serum adiponectin,fasting blood glucose and high sensitivity C-reactive protein (hs-CRP) levels were detected. Results The adiponectin levels of type 2 diabetes group was significantly lower,the fasting blood glucose and hs-CRP of lesion group significantly increased,compared with the no lesion group (P><0.05); The adiponectin levels of moderate and severe stenosis group was significantly lower,the fasting blood glucose and hs-CRP of moderate and severe stenosis group significantly increased,compared with the mild stenosis group (P><0.05); The adiponectin levels of severe stenosis group was significantly lower,the fasting blood glucose and hs-CRP of severe stenosis group significantly increased,compared with the moderate stenosis group (P><0.05). The adiponectin levels and hs-CRP levels and degree of arterial involvement was significantly negatively correlated (r=-0.469 2,-0.392 5,P><0.01),while the hs-CRP levels and degree of arterial involvement were significantly correlated (r=0.892 5,P><0.01). Conclusion The adiponectin levels and carotid artery stenosis has a good correlation,the low adiponectin levels is a good indicator for predicting the diabetic patients,the occurrence of coronary atherosclerosis and the extent of lesion development.