Objective To investigate the association of neutrophil-lymphocyte ratio (NLR) with grade of arteriosclerosis (AS) in the lower extremities in the patients with type 2 diabetes mellitus (T2DM). Methods A total of 556 T2DM patients admitted to our hospital from September 2017 to September 2018 were recruited in this study, and divided into 4 groups according to the results of AS grading, that is, T2DM+AS1 group (n=140, without AS), T2DM+AS2 group (n=98), T2DM+AS3 group (n=192) and T2DM+AS4 group (n=126). The clinical indices of 4 groups were collected and compared. SPSS statistics 17.0 was used for data analysis. Results Significant differences were seen in age, gender, history of smoking, course of T2DM, history of hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), neutrophil count, lymphocyte count, NLR, and levels of creatinine(Cr) and low-density lipoprotein cholesterol (LDL-C) among the 4 groups (P<0.05). Spearman correlation analysis showed that NLR was positively correlated with age, history of hypertension, SBP and Cr level in T2DM AS patients (P<0.05). Binary logistic regression analysis indicated that age (OR=1.111, 95%CI 1.076-1.147; P=0.001), LDL-C (OR=1.506,5%CI 1.011-2.243; P=0.044) and NLR (OR=1.564,5%CI 1.185-2.065; P=0.002) were the influencing factors of lower limb AS in T2DM patients. Multinomial logistic regression analysis suggested that NLR was an independent risk factor for AS grade 4 of the lower extremities in T2DM patients (OR=1.777,5%CI 1.086-2.910; P=0.022), and age was also a risk factor for different grades of AS, and the risk of AS grade 3 and 4 for male patients was 4.037 and 7.819 times higher than that of female patients, respectively; LDL-C and smoking history were risk factors for AS grade 3 in patients with T2DM. Conclusion NLR is closely related with AS in lower extremities in T2DM patients, especially closely related to AS grade 4.