Objective To examine the prevalence of normal, low and high ankle-brachial index(ABI) in patients with type 2 diabetes and the relative risk factors. Methods A total of 3924 patients, who underwent ABI examination in our center between September 2003 and June 2010 , were enrolled. Their medical profiles and laboratory data were analyzed retrospectively. The risk factors for abnormal ABI were determined using univariate and stepwise Logistic regression analysis. Results ABI was normal in 3653 patients(93.1%), ＜0.9 in 206 patients(5.2%), and ≥ 1.3 in 65 patients(1.7%). Elderly patients (≥65 years) had a higher prevalence of low ABI than non-elderly patients(＜65years)( (12.2% vs 3.6%). Using normal ABI as referent, low ABI in non-elderly patients was independently associated with HbA1c, urine albumin to creatinine ratio, diabetic peripheral neuropathy, diabetic retinopathy and cerebral vascular disease. Low ABI in elderly patients was independently associated with age, smoking, HbA1c, uric acid, total cholesterol, diabetic peripheral neuropathy, diabetic retinopathy, diabetic nephropathy and cerebral vascular disease. High ABI in non-elderly patients was associated with male gender. Conclusions The prevalence of abnormal ABI is high in patients with type 2 diabetes, especially in elderly patients. Early identification and intensive treatment are strongly recommended to improve the patients? life quality and overall prognosis.