BACKGROUND: This study examines the association between six types of carotid artery disease image-based phenotypes and HbA1c in diabetes patients. Six phenotypes (intima-media thickness measurements (cIMT (ave.), cIMT (max.), cIMT (min.)), bidirectional wall variability (cIMTV), morphology-based total plaque area (mTPA), and composite risk score (CRS)) were measured in an automated setting using AtheroEdge (AtheroPoint, CA, USA). METHOD: Consecutive 199 patients (157M, age: 68.96+/-10.98 years), L/R common carotid artery (CCA; 398 US scans) who underwent a carotid ultrasound (L/R) were retrospectively analyzed using AtheroEdge system. Two operators (novice and experienced) manually calibrated all the US scans using AtheroEdge. Logistic regression (LR) and Odds ratio (OR) was computed and phenotypes were ranked. RESULTS: The baseline results showed 150 low-risk patients (HbA1c<6.50mg/dl) and 49 high-risk patients (HbA1c>/=6.50mg/dl). The fasting blood sugar (FBS) was highly associated with HbA1c (P<0.001). Except for cIMTV, all phenotypes showed an OR > 1.0 (P<0.001) for left common carotid artery (LCCA), right carotid artery (RCCA), and mean of left and right common carotid artery (MCCA). After adjusting the FBS, the OR for mTPA showed a higher risk for LCCA, RCCA, and MCCA. The coefficient of correlation (CC) between phenotypes and HbA1c were strong and inter-CC between cIMT and mTPA/CRS was above 0.9 (P<0.001). The statistical tests showed that phenotypes were significantly associated with diabetes (P-value<0.0001). CONCLUSIONS: All phenotypes using AtheroEdge, except cIMTV, showed a strong association with HbA1c. mTPA and CRS were equally strong phenotypes as cIMT. The CRS phenotype showed the strongest relationship to HbA1c.