Abstract: Background: Peripheral arterial disease (PAD) is a common cardiovascular complication in patients with type 2 diabetes mellitus (T2DM).Platelet-activating factor acetylhydrolase (PAF-AH) is a biomarker of vascular inflammation. The purpose of this study was to evaluate the influence of T2DMon PAF-AH activity in patients with or without PAD. Methods: cross sectional case control study included 180 subjects were stratified into control andT2DMgroup, the enzymatic activity of (PAF-AH) was determined by a colorimetric assay. Results: there were significant higher values of serum PAF-AH in patients with T2DM with moderate and sever PAD compared to patients with mild PAD. Regarding ankle-brachial index (ABI) there was highly significant lower values in moderate and sever diabetic patient with PAD compared to patients with mild PAD. By linear regression analysis test body mass index, HDL, LDL and fasting plasma glucose were independently correlated with PAF-AH. Receiver operating characteristic analyses (ROC) revealed that the sensitivity and specificity power of PAF-AH among T2DM patients were (97.5%, 60% respectively). Conclusion: plasma PAF-AH levels are significant high in T2DM patients as well as patients with severe PAD and strongly correlated with ABI as well as other lipid and metabolic disorders.