This study investigates the connection between abnormal liver enzymes and macro vascular disease in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD). Clinical data from 276 T2DM patients with NAFLD were retrospectively examined and divided into two groups based on the presence or absence of macro vascular disease. Various biochemical markers were tested, including fasting C-peptide, total bilirubin (TBil), total protein (TP), albumin (Alb), C-reactive protein (CRP) and the insulin resistance index (HOMA-IR). The study found no significant differences in demographic variables between the two groups. However, patients with macro vascular disease had significantly higher levels of fasting C-peptide, CRP, HOMA-IR, TBil, TP, Alb and certain blood lipid markers. The study concludes that in T2DM patients with NAFLD, increased blood lipids, liver function and inflammatory factors are risk factors for macro vascular disease, suggesting the importance of clinical management to lower macro vascular disease prevalence.