Background: Peripheral artery disease (PAD) in lower extremities is a common complication in type 2 diabetes and has shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) and the ABI in combination would improve prediction of mortality.Methods: We retrospectively collected the data of patients with type 2 diabetes who had undergone measurement of ABI and %MAP at our hospital. We separated the cohort into four groups according to the ABI and %MAP values, and examined these indices were associated with mortality.Results: A total of 5101 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of enrolled patients died. The combination of ABI and %MAP was significantly better at predicting mortality than ABI alone. (C index: 0.62 [95% CI: 0.57, 0.65] vs. 0.57 [95% CI: 0.53, 0.62], P = 0.038). In multivariate analysis (with ABI >0.90 and %MAP ≤45% as the reference group), the highest risk of mortality was seen in patients with ABI ≤0.90 and %MAP >45% (hazard ratio = 1.983 [95% CI: 1.380, 2.848], P < 0.001).Conclusions: Adding %MAP to ABI appears to significantly improve the predictive ability for all-cause mortality in patients with type 2 diabetes.