Objective To investigate the factors affecting the clustering of cardiovascular risk factors in Chinese patients with diabetes. Methods Six hundred and fifty four patients with diabetes were examined comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and 2h after a meal. Results were analyzed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes. Results Cardiovascular risk factors were common in Chinese diabetic patients. Clustering of three or more of these factors with diabetes occurred greater than that by random one factor alone and was associated with postprandial hyperinsulinemia. Patients with more risk factors were more prone to macrovascular events. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more females with multiple risk factors. But the difference disappeared if the same criteria were used for males and females. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients. Conclusion The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is possibly associated with hyperinsulinemia and gender.