Objective: This study sought to assess the hypothesis that anemia is associated with diabetic retinopathy in type 2 diabetes mellitus (DM) and investigate the factors mediating the relationship between anemia and diabetic retinopathy. Methods: A total of 1637 individuals with type 2 DM were investigated. Anemia was defined as hemoglobin level < 120 g/L in women and < 130 g/L in men. A logistic regression model was used to determine the association between anemia and diabetic retinopathy. Results: Anemia was more prevalent in individuals with diabetic retinopathy. Logistic regression analysis found a statistically significant association between anemia and diabetic retinopathy after adjustment for traditional risk factors (odds ratio, 1.44; 95% confidence interval, 1.10-1.89, p = 0.009). Further adjustment for serum bilirubin levels removed the statistically significant association. Conclusion: In individuals with type 2 DM, anemia is related to diabetic retinopathy, and its association may be mediated by a correlated change in serum bilirubin levels.