Objective: To investigate the cardiovascular disease (CVD) risk management and its impact on Australian general practice patients with type 2 diabetes in urban and rural areas between 2000 and 2002, and to compare trends over time and differences between urban and rural areas. Design and methods: Population-based repeated cross-sectional study. 6305 patient records from 2000 to 2002 were extracted from registers of diabetes type 2 patients held by 16 Divisions of General Practice (250 practices) across Australia. Multivariate logistic regression comparing urban and rural patients at differing time-periods and comparing trend changes was conducted using multilevel analysis. Results: Prescribing of antihypertensive and lipid-lowering medications was infrequent but increased in both urban and rural areas from 2000 to 2002 (p < 0.05), while attendance at other allied health professionals did not. While the proportion of patients meeting targets for high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol increased in both areas over time, only in urban areas were there improvements in total cholesterol and blood pressure over time. The proportion of patients meeting targets for HDL-C, triglycerides and smoking cessation were higher in urban areas than in rural areas by 2002. Conclusions: Despite a number of national initiatives to improve general practice care and specifically support better care in rural areas, cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes was still suboptimal during the study period especially among patients from rural areas. Greater effort will be required to reduce the disparity in risk factor prevention for CVD between urban and rural people with type 2 diabetes in Australia.