BACKGROUND: Type 2 diabetes (T2D) is increasingly recognized as a significant global health challenge, with a rising prevalence of hyperlipidemia among diabetic patients. Effectively predicting and reducing the risk of hyperlipidemia in T2D patients to mitigate their cardiovascular risk remains an urgent issue. OBJECTIVES: The research sought to determine early clinical indicators that could predict the onset of hyperlipidemia in patients with T2D and to establish a predictive model that integrates clinical and laboratory indicators. METHODS: A cohort of T2D patients, excluding those with pre-existing hyperlipidemia or confounding factors, was analyzed. Clinical and laboratory data were used in a LASSO regression model to select key predictive variables. A nomogram was then constructed and evaluated using receiver operating characteristic (ROC) analysis and calibration. RESULTS: Among 269 participants, PCSK9 levels were significantly elevated in T2D patients with hyperlipidemia and exhibited a positive correlation with several lipid markers. LASSO regression identified six predictors: BMI, TG, TC, LDL-C, HbA1c, and PCSK9. The nomogram model exhibited robust predictive performance (AUC, 0.89 (95% CI: 0.802-0.977)) and showed good calibration. CONCLUSIONS: This method effectively predicts the risk of hyperlipidemia in patients with T2D and provides a valuable tool for early intervention. PCSK9, as a key predictor, highlights its potential role in the pathogenesis of diabetes with hyperlipidemia and offers new avenues for targeted therapy.