Purpose The purpose of this exploratory, descriptive, correlational study was to describe the perceived risk for diabetes complications among urban African American adults (18-75 years old) with type 2 diabetes and to explore the interrelationships among illness perception, well-being, perceptions of risk for diabetes complications, and selected physiologic measures of diabetes risk: hemoglobin A1C, blood pressure, and microalbuminuria. Methods Urban African American adults with type 2 diabetes (N = 143) were recruited from 3 Chicago city public health clinics. They completed a demographic survey and 3 instruments: the Risk Perception Survey-Diabetes Mellitus, the 12-item Well-being Questionnaire, and the Revised Illness Perception Questionnaire. Physiologic measures included blood pressure, urine for microalbuminuria, and capillary blood for A1C. Results There was low perception of risk for diabetes complications, which was incongruent with the physiologic measures of risk. Less than 33% of participants saw themselves as being at high risk for developing any complications of diabetes, with the exception of vision problems (39%), despite the fact that physiologic measures of risk for diabetes complications were high in this sample. Conclusions Risk perception was associated with well-being, perception of negative consequences, number of symptoms, and negative emotions related to diabetes. Risk perception was not in line with risk, as indicated by physiologic measures; thus, it is necessary to heighten this population's perception of risk for diabetes complications.