Objective To investigate the alteration of carotid artery intima media thickness (C-IMT) in the elderly patients with type 2 diabetes mellitus (T2DM) and trace albumin in the urine (microalbuminuria, MAU). Methods A total of 180 elderly T2DM patients hospitalized in our department were recruited in this study. According to complication of MAU or not, they were divided into MAU group (n=60) and non-MAU group (n=120). Their clinical data and related indices were detected and compared between the 2 groups. Results Compared with the non-MAU group, the MAU group had significantly higher triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), serum creatinine (Scr), incidence of plaque, C-IMT, resistance index (RI) and pulsatility index (PI), but obviously lower glomerular filtration rate (GFR), lumen diameter, carotid peak systolic blood flow velocity (PSV) and end diastolic velocity (EDV) (all P<0.05).The level of MAU was increased with the increase of sclerotic plaque index (F=29.874, P<0.001). Multiple linear regression analysis indicated that C-IMT was positively correlated with the MAU level in the elderly T2DM patients complicated with MAU. Conclusion C-IMT and MAU are closely associated in the elderly T2DM patients complicated with MAU. Detection of MAU is of value in the early diagnosis of cardiovascular and cerebrovascular diseases in these patients.