Aim To investigate the relationship between the concentration of serum total bilirubin and artery intima-medial thickness(IMT) in newly diagnosed type 2 diabetes patients. Methods 357 newly diagnosed type 2 diabetes patients(age 35～70,duration≤1year)were recruited,178 patients with higher IMT and 179 patients with normal IMT,and then clinical feature and serum total bilirubin were compared in the two groups.Based on the concentration of serum total bilirrubin these patients were divided into four groups: lowest bilirubin group,lower bilirubin group,higher bilirubin group,highest bilirubin group,and patients' common carotid artery(CCA)-IMT,common iliac artery(CIA)-IMT,femoral artery(FA)-IMT and the incidence rate of plaque were compared in four groups.Serum total billirubin and other factors related to diabetic subclinical atherosclerosis were analyzed by multiple stepwise Logistic regressive analysis. Results The concentration of serum total bilirubin of the IMT thickening group was significantly lower than that of the IMT normal group(P><0.05).Among the four groups which were divided based on the concentration of serum total bilirubin,the lowest bilirubin group's CCA-IMT,CIA-IMT,FA-IMT,the incidence rate of plaque and higher IMT was the highest in the four groups,and was significantly higher than highest bilirubin group's(P><0.01).To define the independent association between serum total bilirubin and diabetic artery IMT,the multiple stepwise Logistic regressive analysis was used.Serum total bilirubin,but not other parameters,was related independently and significantly with higher IMT,so did age and systolic hypertension. Conclusion The study suggested that serum total bilirubin was probably an independent risk factor for higher IMT in newly diagnosed type 2 diabetes.