Objective: To explore the correlation between neutrophil to lymphocyte ratio (NLR) and Framingham stroke risk level in patients with type 2 diabetes mellitus (T2DM), and to reveal its predictive value for high risk of stroke. Methods: A total of 449 patients with T2DM who were hospitalized in the Department of Endocrinology of the Affiliated Hospital of Xuzhou Medical University from September 2018 to September 2019 were selected as the study subjects. According to the modified Framingham stroke profile(FSP), they were divided into low-risk group (176 cases), medium-risk group (121 cases) and high-risk group (152 cases). The clinical data of different groups were compared. Spearman correlation analysis was used to analyze the relationship between NLR and various indexes. Ordinal multi-classification logistic regression model was used to screen the risk factors affecting stock risk level. The predictive value of NLR for high risk of stroke was depicted by ROC curve. Results: Among three groups, a statistically significant difference (P<0.05) was found in NLR (low-risk group < moderate-risk group < high-risk group). Spearman correlation analysis showed that NLR had significant positive correlation with FSP (rs=0.388, P<0.05). Ordinal multi-classification logistic regression analysis showed that NLR was the risk factor of the Framingham stroke risk level. The area under the ROC curve of NLR predicting high-risk stroke was 0.714. Conclusion: In patients with T2DM, NLR is associated with Framingham stroke risk level, and may have a certain predictive value for high-risk stroke.