Particularly in tropical areas with limited access to sophisticated diagnostics, type 2 diabetes mellitus (T2DM) is a significant risk factor for cardiovascular disease (CVD). Although the Framingham Risk Score (FRS) is frequently used to estimate CVD risk, there is ongoing debate about its accuracy in the diabetic population. Thus, further techniques are required to improve risk stratification, such as using ultrasound to quantify carotid intima-media thickness (CIMT), a noninvasive indicator of subclinical atherosclerosis. The purpose of this study was to evaluate the association between FRS and CIMT in T2DM patients in tropical urban areas with no prior history of CVD. This study uses secondary data from 165 T2DM patients included in the Bogor study who were at least 30 years old. 2021 Non-Communicable Disease (NCD) Cohort Study. Bilateral carotid ultrasonography was used to measure CIMT, and FRS was used to estimate the 10-year risk of CVD. Multivariate linear regression with perturbation factor adjustment and the Pearson correlation test were used. The findings revealed that 56.97% of respondents fell into the high cardiovascular risk category, with an average CIMT of 0.63 ± 0.12 mm and a median FRS of 22.41% (IQR: 14.00–33.91). FRS and CIMT showed a weak but substantial positive connection (r = 0.312; p < 0.001. The LDL cholesterol constituted a significant disruptive factor. These results suggest that CIMT could be a valuable tool for evaluating cardiovascular risk in patients with T2DM. However, the association is not very strong, especially in tropical areas where diagnostic tools are limited. © 2026 Richard et al. and 2026 the authors.