Aim To explore the correlation between residual lipoprotein cholesterol (RLP-C) and the occurrence and severity of peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM). Methods 392 T2DM patients with complete data who attended the Department of Endocrinology and the Department of Cardiovascular Medicine of People's Hospital of Henan University of Traditional Chinese Medicine from May 2022 to December 2022 were selected and classified into PAD group (n＝203) and non-PAD group (n＝189). General clinical data were collected between the groups, the difference of RLP-C level was compared between the two groups, the correlation between RLP-C and PAD was examined by using univariate and multivariate Logistic regression analysis, and ROC curve was plotted to analyze the predictive value of RLP-C for PAD. Results Compared with non-PAD group, RLP-C level was significantly higher in PAD group (P＜0.001); RLP-C was positively correlated with the severity of PAD (r＝0.443, P＜0.001); Multifactorial Logistic regression analysis revealed that RLP-C was a major risk factor for the development of PAD in T2DM (P＜0.001); The area under the curve (AUC) of RLP-C level prediction for T2DM combined with PAD was 0.860 (95%CI: 0.824～0.896, P＜0.001); The optimal RLP-C threshold for predicting the development of PAD was 0.67 mmol/L. Conclusion RLP-C level was positively associated with the occurrence and severity of PAD in patients with T2DM, and RLP-C was an independent risk factor for the development of PAD. In addition, RLP-C＞0.67 mmol/L increased the risk of PAD in T2DM patients.