Objective: To evaluate the left ventricular twist characteristics in patients with type 2 diabetes by using two-dimensional speckle tracking imaging(STI）. Methods: Ninety-three patients with type 2 diabetes admitted in Zhejiang Hospital from May 2012 to September 2013 were enrolled. According to left ventricular ejection fraction(LVEF）, patients were divided into two groups: normal left ventricular systolic function group(group A, LVEF≥0.50, n=46 ）and abnormal left ventricular systolic function group （group B, LVEF < 0.50, n=47 ）. Forty-six healthy subjects were selected as normal controls. STI was applied to quantitatively analyze the left ventricular twist. Correlation of the peak of left ventricular twist angle （Peaktw）, aortic valve closure time twist angle （AVCtw）, and mitral valve opening time twist angle （MVOtw）with LVEF, Tei index, E/A, and E/e was evaluated. Consistency check for STI was conducted to assess its stability and reliability. Results: The Peaktw, AVCtw, and MVOtw in group A were significantly elevated than those in normal controls ( Ps < 0.05）. The Peaktw, AVCtw, and MVOtw in group B was lower than those in normal controls and group A （ Ps <0.05）. In diabetic patients, the Peaktw, AVCtw, MVOtw were positively correlated with LVEF （r=0.968, 0.966, 0.938; Ps< 0.05）and E/A （r=0.798, 0.790, 0.788;  Ps <0.05）, and were negatively correlated with Tei index （r=-0. 834, -0.811, -0.797; Ps< 0.05）and E/e （r=-0.823, -0.805, -0.771; Ps <0.05）.The agreement  between measurers and within measurers of Peaktw was satisfactory（between measurers: R=0.957, bias=-0.1, 95% consistency limit=-2.8-2.7; within measurer: R=0.964, bias=-0.2, 95% consistency limits=-2.7-2.2）. Conclusion: STI can be used for early recognition of abnormal changes of cardiac function in type 2 diabetic mellitus patients, with high stability and reliability.