Background: Type 2 diabetes mellitus (T2DM) is a major cardiovascular risk factor, yet echocardiographic data from the Jazan region of Saudi Arabia are scarce. Methods: This retrospective case-control study included Adults 168 patients with T2DM and 160 non-diabetic controls, (age- and gender are matched), who underwent transthoracic echocardiography at two hospitals in Jazan in period from (October 2024 to April 2026). Clinical, demographic, and echocardiographic data were retrieved from electronic medical records. Results: Echocardiographic abnormalities were detected in 85.1% of diabetic patients. The most common findings were mitral regurgitation (40.5%), left ventricular hypertrophy (30.4%), and tricuspid regurgitation (27.4%). Diabetes duration ≥10 years was a significant risk factor (OR 8.6, p=0.041). BMI <25 kg/m² showed a protective effect in logistic regression (p=0.011), though abnormalities were prevalent across all BMI categories. Compared with controls, diabetic patients had significantly higher LVIDS, LVIDD, ESV, and aortic root area (all p<0.05), with reduced fractional shortening. Conclusion: In Jazan, echocardiographic abnormalities are common, especially among T2DM patients, where significant risk factors include diabetes duration and BMI. Cardiac screening should be performed routinely, regardless of BMI, as it helps identify and manage cardiac abnormalities.