Aim This study aims to investigate the effect of a cardiovascular risk (CVR) communication intervention on the accuracy of CVR perception, diabetes self-care (DSC), glycosylated hemoglobin percent (HbA1c%), and CVR in patients with type 2 diabetes mellitus (T2DM). Subject and methods A randomized controlled trial was performed in T2DM patients attending the family medicine outpatient clinic in Suez Canal University Hospital, Ismailia. The intervention group (n = 107) received a comprehensive CVR communication. Control subjects (n = 107) received the standard usual care. The outcome measures were: accuracy of risk perception, DSC, HbA1c%, and CVR scores. Patients were investigated at baseline and 3 months after the intervention. Differences between arms were assessed using chi-square and Student's t-test, and within-group differences were assessed using the paired t-test and McNemar's test. Results After the intervention, the accuracy rate of risk perception was significantly improved (from 44.9 % to 89.7 %) in the intervention group with excellent improvement in agreement between perceived and objective risk (kappa ± SE 83.7 ± 4.4 %, p < 0.000). Diabetes self-care sum scale scores and HbA1c% showed statistically significant improvements for within-intervention group comparisons and between groups after the intervention (p < 0.000). Cardiovascular risk scores showed minimal, not statistically significant improvement in both groups. Conclusion Our intervention significantly improved CVR perception, DSC, and HbA1c% in patients with T2DM. Further research is needed to investigate the effectiveness of applying more complex and longer lifestyle interventions and to confirm the credibility and sustainability of improvement.