This study aimed to investigate the adequacy of the visual-motor integration (VMI) scale for Korean elderly (VMIS-KE) compared to traditional measures, mini-mental state examination of Korean version (MMSE-KC) and Beery VMI for cognitive decline in diabetic older adults. For this explanatory research, data were collected from September 1 to September 15, 2013, from 34 diabetic older adults and 31 nondiabetic older adults in Daegu and Gyeongsan of Korea. Mean differences between the two groups were analyzed with SPSS 18.0. The diabetic older adults showed significantly lower scores in the VMIS-KE (<i>t</i>= 4.128, <i>P</i>< 0.001) and MMSE-KC (<i>t</i>= 2.231, <i>P</i>= 0.029) compared with the nondiabetic older adults. In all subcategories of VMI-KE, figure cognition (<i>t</i>= 5.342, <i>P</i>< 0.001), memory (<i>t</i>= 3.011, <i>P</i>= 0.004) and spatial cognition (<i>t</i>= 2.639, <i>P</i>= 0.011), there were significant differences whereas no significant difference in the VMI-6th revision (<i>t</i>= 0.994, <i>P</i>= 0.325). VMIS-KE could be a sensitive indicator to assess cognitive change in older adults with diabetes and health care providers should periodically evaluate vulnerable groups such as them with it.