Aims: Patients with type 2 diabetes are at a two- to four-fold higher risk of developing cardiovascular disease (CVD) compared with those without diabetes, thus an early assessment of their CV risk is essential. ESC Cardiovascular risk collaboration have created a new model to estimate 10-year CV risk using the SCORE2-Diabetes algorithm in diabetic patients aged ≥40 years. Despite some advantages several question regarding SCORE2-Diaebtes are needed to be addressed. The aim of this study was to evaluate the association between CV risk stratified with SCORE2-Diabetes and early CV damage evaluated with arterial stiffness and intima-media thickness (IMT). Methods: Pulse wave velocity (PWV), IMT and carotid atherosclerosis were evaluated in 135 subjects with diabetes aged 40-69 years, stratified according to SCORE2-Diabetes into four risk groups: low (n=11), medium (n=17), high (n=40) and very high (n=67) risk. Results: PWV was significantly increased from Low to Very High CV risk groups (7.2±1.1 m/s, 8.7±1.9 m/s, 9.8±2.3 m/s, 12.2±4.5 m/s). Similar statistically significant results were obtained for IMT, with progressively higher values as the risk classes increase (0.68±0.11 mm, 0.78±0.13 mm, 0.83±0.12 mm, 0.87±0.17 mm). Then, patients with very high risk were found to have a higher prevalence of carotid atherosclerosis than the other groups (low 0%, moderate 25%, high 22,7%, very high 64%). Finally, we divided patients with established CVD and target-organ damage (TOD) from very high risk group according to SCORE2-Diabetes; we found no statistically significant difference in the considered parameters between the two groups. Conclusions: We found increasing PWV and IMT in diabetic patients with progressively increasing risk classes evaluated through SCORE2-Diabetes and a higher prevalence of carotid atherosclerosis in patients of very high risk group. Moreover, patients of very high risk group had similar CV profile than patients with established CVD, showing the reliability of SCORE2-Diabetes in estimating CV risk.