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Maisa A Wahab,1 Alshaymaa M Alhabibi,2 Ahmed Khairy Sakr,1 Mohamed Yahia Zakaria,3 Ola I Saleh,4 Inass Hassan Ahmad,5 Eman Kamel Abdelrahman,6 Randa Sabour Elshahat Taha,4 Fayka Karem Abdel Azeem Ahmed,4 Bothayna Ismail,2 Lamiaa Hosney Azel,5 Asmaa S Hassan,2 Hanaa Mohammed Eid El Sayed,7 Sammar Ahmed Kasim,7 Safaa Abdelfattah Elsharkawy8 1Department of Vascular Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 2Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 3Department of Vascular and Endovascular Surgery, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt; 4Department of Radio-Diagnosis, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 5Department of Endocrinology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 6Department of Internal Medicine, Faculty of Medicine, Port Said University, Port Said, Egypt; 7Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 8Department of Community Medicine and Occupational Health, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EgyptCorrespondence: Alshaymaa M Alhabibi, Tel +201002894075, Email alshaymaa.alhabibi@yahoo.comBackground: One of the major issues affecting global health is Diabetes mellitus (DM), not only in terms of the disease itself but also its complications. Macrovascular complications are both common and serious, affecting many patients. This study aimed to assess fasting C-peptide levels and correlate them with the severity of the peripheral arterial disease complicating type 2 DM (T2DM).Patients and Methods: This study included 200 participants who were categorized into two groups: Group I (n=100, patients with T2DM complicated by femoropopliteal arterial atherosclerosis) and Group II (n=100, healthy age- and sex-matched individuals serving as controls). Fasting C-peptide levels were estimated using an immunochemiluminometric assay.Results: Fasting C-peptide levels were significantly higher in Group I than in the control group. Fasting C-peptide levels were positively correlated with the severity of atherosclerosis. In addition, the receiver operating characteristic (ROC) curve analysis revealed that fasting C-peptide levels served as a specific and sensitive marker for detecting the severity of this disease.Conclusion: Fasting C-peptide levels can be used as a sensitive and specific indicator of the severity of femoropopliteal arteriosclerosis that complicates T2DM.Keywords: diabetes mellitus, femoropopliteal arteriosclerosis, fasting C-peptide