Objective To investigate the effects of tele-nursing education and guidance on coronary atherosclerotic plaque progression in patients with type 2 diabetes mellitus (T2DM). Methods This study included 825 T2DM patients who underwent coronary artery angiography and had the coronary plaque reevaluated approximately one year thereafter. The baseline clinical characteristics and laboratory parameters were documented and routine healthcare education was given at hospital. The participants were than divided into tele-nursing education group (n=397), who were offered tele-nursing education and guidance after discharge (once every three months), and control group (n=428). Results Tele-nursing education group had significantly lower ratio of coronary plaque progression than control group (P<0.05). Significant difference was also observed between the two group patients regarding self-management behavior, self-monitering of blood glucose level, self-monitering of blood pressure, and medication compliance (all P<0.05). Multivariate regression analysis revealed that tele-nursing education was independently associated with ameliorated coronary plaque progression in T2DM patients, while smoking, high blood pressure and glucose level were risk factor for the progression of coronary plaque. Conclusions Tele-nursing education and guidance exert positive effect on coronary plaque progression in T2DM patients.