Objective To investigate the quantitative changes of microflow parameters of optical coherence tomography angiography (OCTA) in the early asymptomatic stage of diabetic retinopathy (DR), and to construct a multi-parameter combination of DR early risk stratification model and verify its clinical efficacy. Methods A total of 80 patients (80 eyes) with type 2 diabetes who presented at the First Affiliated Hospital of Bengbu Medical University from January 2023 to December 2025, were retrospectively included. They were divided into low-risk group (n＝32), medium-risk group (n＝28) and high-risk group (n＝20) according to the risk factors of early DR. All subjects underwent OCTA scanning, and OCTA parameters were collected, including the vessel density (VD) and perfusion density (PD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the area of the foveal avascular zone (FAZ-A), the perimeter of the foveal avascular zone (FAZ-P), and the capillary density in the FD-300 area. At the same time, clinical indicators such as fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c) and diabetes course of the subjects were collected. Results As the risk level increased, SCP-VD, DCP-VD, FD-300 (SCP), and 6 mm×6 mm outer-layer VD showed a stepwise decrease, while FAZ-A and FAZ-P showed a stepwise increase (all P＜0.05); however, there was no significant difference in 3 mm×3 mm PD between groups (P＝0.062). Through the least absolute shrinkage and selection operator (LASSO) regression, five independent variables, namely SCP-VD, DCP-VD, 6 mm×6 mm outer-layer VD, FAZ-P, and the diabetes course, were selected from 14 candidate parameters and incorporated into the final model. The training set model AUC was 0.842 (95%CI: 0.761?0.923), the validation set AUC was 0.817 (95%CI: 0.728?0.906), the calibration curve Bootstrap corrected Brier score was 0.138, and the decision curve analysis (DCA) showed that the net benefit of the model was better than the“ all intervention” or“ all no intervention” strategy in the threshold probability range of 0.20?0.70. Conclusion The microflow parameters of OCTA can sensitively reflect the early microcirculation damage of DR. The Logistic risk stratification model based on microflow parameters of OCTA combined with the course of diabetes has good early warning value for the risk of early progression of DR, and can provide quantitative basis for the formulation of clinical individualized follow-up interval and early intervention.