The Glycemic Risk Index (GRI) is a novel composite glycemic indicator, but its role in peripheral atherosclerotic lesions in type 2 diabetes (T2D) remains unclear. This study examined the association between GRI and the severity of peripheral atherosclerotic lesions in T2D patients and assessed its value in identifying high-risk individuals.

This retrospective study included 878 T2D patients hospitalized at the Second Hospital of Jilin University from October 2023 to October 2025. Patients were divided into no-lesion (n=88), single-lesion (n=287), and dual-lesion (n=503) groups by carotid plus lower extremity arterial ultrasound examinations and stratified by GRI quartiles. The performance of GRI in identifying vascular lesion risk was compared with traditional indicators, including TIR and HbA1c. Multivariate ordinal logistic regression and subgroup analyses were conducted.

Higher GRI quartiles were associated with poorer glycemic control, greater variability, and higher prevalence of peripheral atherosclerosis (86%–95% from Q1 to Q4), while TIR and HbA1c showed no similar trend. After full adjustment, the highest GRI quartile conferred a 76% higher risk of more severe atherosclerosis versus Q1 (OR=1.76, 95%CI:1.15–2.70, P  = 0.009; P for trend = 0.002). This association was stronger in overweight patients (BMI≥24 kg/m², P for interaction=0.03).

GRI is independently and positively associated with the severity of peripheral atherosclerotic lesions in T2D and outperforms traditional glycemic indicators, especially in overweight individuals, supporting its clinical use for atherosclerosis risk stratification.