Objective To investigate the diagnostic value of uric acid/high-density lipoprotein cholesterol ratio （UHR）， monocyte count/high-density lipoprotein cholesterol ratio （MHR）， and 25-hydroxyvitamin D ［25（OH）D］ levels in lower extremity artery disease （LEAD） of type 2 diabetes mellitus （T2DM）. Methods This retrospective study analyzed 166 T2DM patients hospitalized at the Department of Endocrinology， Second Affiliated Hospital of Zhengzhou University from April 2024 to September 2025. Patients were categorized into T2DM with LEAD （82 cases） and T2DM without LEAD （84 cases） based on the presence of lower extremity artery disease. General demographics and biochemical markers were compared between groups. Logistic regression was used to identify risk factors for LEAD development， while Pearson correlation analysis evaluated the relationships between UHR， MHR， 25（OH）D， and other biochemical indicators. ROC curves were constructed to assess diagnostic value. Results The T2DM with LEAD group showed statistically significant differences （P < 0.05） compared to the T2DM without LEAD group in male proportion， age， disease duration， uric acid levels， monocyte count， UHR， and MHR， whereas high-density lipoprotein cholesterol （HDL-C） and 25（OH）D levels were lower in the former group. Pearson correlation analysis revealed negative associations between UHR and 25（OH）D， low-density lipoprotein cholesterol （LDL-C）， and total cholesterol （P < 0.05）， while showing positive correlations with serum creatinine and monocyte count （P < 0.05）. MHR exhibited negative correlations with LDL-C， total cholesterol， and non-HDL cholesterol （P < 0.05）.Univariate logistic regression analysis showed that gender， age， disease duration， UHR， MHR， and 25（OH）D were independent risk factors for LEAD in patients with T2DM. After adjusting for confounding factors such as gender， age， and disease duration. Multivariate logistic regression analysis identified UHR， MHR， and 25（OH）D as significant predictors of LEAD development in T2DM patients. ROC curve analysis demonstrated that the area under the curve （AUC） for diagnosing T2DM with LEAD using UHR， MHR， and 25（OH）D levels was 0.822，0.774， and 0.784 （P < 0.05）， respectively， with the combined use of these three markers yielded a significantly higher AUC reaching 0.927 （P < 0.05）， After internal validation by Bootstrap resampling， the corrected AUC was 0.921. Conclusion UHR， MHR， and 25（OH）D levels are key factors influencing LEAD development in T2DM patients， and their combined use significantly improves early diagnostic accuracy timely screening and intervention for LEAD complications.