Aim To investigate the relationship between the serum level of glycated albumin (GA) and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus. Methods The serum levels of GA and glycosylated hemoglbin A1c (HbA1c) were measured in 349 consecutive diabetic patients and 340 normal controls. Diabetic patients were further divided into patients without significant coronary stenosis (n=166) and patients with significant coronary stenosis defined as luminal diameter narrowing ≥70% (n=183). Multivariate analysis was performed to determine independent risk factors for significant CAD in patients with type 2 diabetes mellitus. Results The serum GA level was significantly higher in patients with significant coronary stenosis than patients without significant coronary stenosis and controls (P<0.01), and correlated significantly with the number of diseased coronary arteries (r=0.19, P<0.01), whereas no obvious difference was found in HbA1c between the groups. Multivariate analysis revealed that older age, male gender, serum level of GA, lipoprotein (a) and hypertension were independent risk factors for significant CAD in diabetic patients. Conclusions The serum level of GA is associated with the presence and severity of CAD in patients with type 2 diabetes mellitus.