Introduction: Type 2 diabetes mellitus (DM) is a cluster of conditions categorized by longstanding hyperglycemia accompanying with disturbances of carbohydrate, lipid and protein metabolism due to absolute/relative deficiency of insulin secretion and/or its action. Serum cholinesterase is an enzyme, which has been associated with diabetes, hypertension, cardio, and vascular disease and also it has a role in the metabolism of lipoproteins. Few studies showed that serum cholinesterase activity has been positively’ correlated with lipid indices and blood lipoprotein levels. Aim and objectives: To estimate serum cholinesterase levels in clinically diagnosed type 2 DM patients and to evaluate the correlation between true cholinesterase level and lipid indices in the type II diabetes patients. Materials and methods: Total 120 subjects were involved in this study. Out of which 60 were clinically diagnosed type II diabetes mellitus cases, and 60 were age and sex-matched healthy controls. Serum cholinesterase enzyme activity, fasting blood glucose levels and lipid profile and indices analysis done in event-eelated brain activation (ERBA) autoanalyzer. Statistical data analysis was performed by using Statistical Package for the Social Sciences (SPSS) 19.2 software. Results: The enzyme cholinesterase activity levels raised in cases compared to healthy controls. The enzyme cholinesterase levels in cases revealed 9576 ± 1542.78 (IU/L) and in controls was 6783.9 ± 798.98 (IU/L). The enzyme cholinesterase showed a positive correlation with every lipid indices namely total cholesterol, triglycerides, low-density lipoprotein-cholesterol (LDL-C), total cholesterol to high-density lipoprotein-cholesterol (HDL-C) ratio and negative correlation with HDL-C in cases as compared to healthy controls. Conclusion: The outcome of our study showed that serum (true) cholinesterase level may assist as a budding risk assessment indicator of cardiovascular disease in type 2 DM.