Background: Irisin is a new myokin and adipokine related to human obesity and insulin resistance status. Aims: To investigate whether serum irisin is related to glycemic indicators and micro and macrvascular complications in patients with T2DM. Methods: The study included 60 T2DM patients and 30 healthy controls. Anthropometric measures, neurological assessment, and fundus examination were done to all patients. Correlations of serum irisin and blood glucose, glycosylated hemoglobin (HbA1C), urinary albumin, estimated glomerular filtration rat (eGFR), C-reactive protein (CRP), and carotid intima media thickness (CIMT) were analyzed using Spearman’s correlation coefficient. Results: In diabetic patients, there was negative correlation between irisin level and duration of diabetes(r = − 0.302, p = 0.023), body mass index (BMI) (r = − 0.663, p < 0.001), HbA1C (r = − 0.528, p < 0.001), urinary albumin (r = − 0.439, p < 0.001), CRP (r = − 0.692, p < 0.001), and CIMT (r = − 0.807, p < 0.001). Levels of irisin were significantly lower in patients with peripheral diabetic neuropathy (PDN) compared to those without PDN (0.11 ± 0.05 vs. 0.22 ± 0.11 ng/ml, p < 0.001). Levels of irisin were not significantly different between patients with diabetic retinopathy and those with normal fundi. Conclusions: In T2DM patients, negative correlations between irisin and HbA1C, urinary albumin, and CIMT were found. Moreover, patients with diabetic neuropathy had lower irisin levels.