Background <p>Unlike neuropathy, there is no universal agreement for screening of peripheral artery disease (PAD) among high risk diabetic patients. Considering the fact that screening of neuropathy is easier and more available, it is important to find if diabetic patients with neuropathy should be considered for screening of PAD.</p> Objective <p>The study aims to explore the association between diabetic peripheral neuropathy, defined as loss of protective sensation (LOPS), and peripheral artery disease (PAD), and whether LOPS can be used as an indicator of PAD among patients with type 2 diabetes mellitus (T2DM).</p> Methods <p>A cross-sectional study was conducted between 2017 and 2023 on adult patients with T2DM referred for PAD and LOPS screening. Clinical, demographic, and laboratory data were collected from electronic medical records. All participants underwent comprehensive foot examinations for LOPS and assessments of ankle-brachial index (ABI) and toe-brachial index (TBI). PAD was defined as ABI ≤ 0.9 or TBI ≤ 0.7 for cases with ABI &gt; 1.3.</p> Results <p>A total of 1,136 patients were included, of whom 611 (53%) were female. LOPS was detected in 766 patients (67%), and PAD was diagnosed in 170 patients (15%). Multivariate logistic regression analysis showed that LOPS was independently associated with PAD (Odds ratio [OR] 2.631, 95% confidence interval [CI]: 1.708–4.054). Additionally, LOPS was associated with reduced ABI (coefficient: –0.0426, 95% CI: –0.0624 to –0.0227) and TBI (coefficient: –0.0700, 95% CI: –0.0944 to –0.0456). BMI was inversely associated with PAD (OR 0.933, 95% CI: 0.896–0.971).</p> Conclusion <p>LOPS is independently associated with an increased risk of PAD in patients with T2DM and may serve as a reliable indicator for PAD screening.</p>