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Objective: Cardiovascular events are high in patients with type II diabetes, whereas their risk stratification is more difficult. The higher risk may be related to differences in coronary plaque burden and composition. The purpose of this study was to evaluate whether differences in the extent and composition of coronary plaques in patients with and without diabetes can be observed using multi slice computed tomography (MSCT).Research design and methods: MSCT was performed in 100 patients (56 [56%] with type II diabetes) we also use HA1c as a predictor to differentiate between controlled and uncontrolled diabetic patients. The number of diseased coronary segments was determined per patient; each diseased segment was classified as showing obstructive (50% luminal narrowing) disease or not. In addition, plaque type (non calcified, mixed, and calcified) was determined. Plaque characteristics were compared in patients with and without diabetes and also between controlled and uncontrolled diabetic patients. Regression analysis was performed to assess the correlation between plaque characteristics and diabetes.Results: Patients with diabetes showed significantly more diseased coronary segments than non diabetic patients (4.870 ± 2.488 vs. 2.130± 1.558, P < 0.001*) with more non obstructive (3.833±2.847vs. 0.567±1.558, P < 0.001*) plaques. Relatively more non calcified (0.833±0.841 vs. 0.348±0.640) and calcified (3.278±2.528 vs. 0.565±0.935) and less mixed (0.741±0.894 vs. 1.217±1.191) plaques were observed in patients with diabetes (P < 0.02). Also patients with uncontrolled diabetes showed significantly more non calcified plaques than patients with controlled diabetes (1.50 ± 0.67vs0.375 ± 0.609, P< 0.001*). Diabetes correlated with the number of diseased segments and non obstructive, non- calcified, and calcified plaques.Conclusions: Differences in coronary plaque characteristics on MSCT were observed between patients with and without diabetes and patients with controlled and uncontrolled diabetes. Diabetes was associated with higher coronary plaque burden. More non calcified and calcified plaques and less mixed plaques were observed in diabetic patients and also more non calcified plaques were observed in uncontrolled diabetic patients. Thus, MSCT may be used to identify differences in coronary plaque burden, which may be useful for risk stratification.