Coronary artery calcium score (CACS) is increasingly used to refine the cardiovascular risk prediction in patients with diabetes worldwide. However, its distribution and determinants in this population remain controversial. We aimed to determine the CACS distribution and determinants in asymptomatic patients with diabetes and to compare them between Limoges and La Reunion and between sex groups. We used the medical records of patients with diabetes who had at least one CACS measurement between 2014 and 2020 in Limoges and La Reunion. CACS was classified into four categories (0: no plaque, 1–99: mild plaque, 100–399: moderate plaque, and ≥ 400: severe plaque). Multinomial logistic regression models were performed to determine the risk factors associated with each CACS categories. In addition, a risk score for having a CACS≥ 400 was created with the patients in Limoges and then tested on those in La Reunion. A total of 577 patients were analyzed (369 from Limoges and 208 from La Reunion). The highest proportion of high CACS was found in Limoges. The multivariate analysis showed that age (OR by 10 years = 3.82[2.45-5.97]), male sex (3.81[1.79-8.09]), diabetic retinopathy (3.45[1.29-9.20]), family history of cardiovascular diseases (3.23[1.44-7.25]) and statine use (3.71[1.25-11.0]) were independent risk factors for CACS≥ 400. The stratified analysis on sex and location showed that male patients had more risk factors for high CACS than female and that in both of the cities the factors associated with high CACS were approximately the same. Similarly, the performance of the created risk score assessed by the receiver operating characteristic curve showed approximately equal areas under the curve (AUC) between Limoges (AUC = 0.74) and La Reunion (AUC = 0.71). In this study, we found that regardless of location, patients with diabetes share the same risk factors for high CACS and that men have more risk factors than women.