Object: The effect of interarm blood pressure difference (IABPD) on the development of diabetic retinopathy (DR) remains unknown when controlling other risk factors such as glycemic levels. We investigated to determine the impact of blood pressure (BP) and IABPD on DR in patients with type 2 diabetes. Methods: 563 patients with diabetes, who were evaluated with a simultaneous bilateral blood pressure (BP) measurement device from Aug 2011 to Mar 2019 at Veterans Health Service Medical Center were included. The cutoff values for IABPD were 5, 10, and 15 mmHg. Logistic regression analysis was used to explore the relation between IABPD and DR. Results: The prevalence of systolic IABPD ≥5, ≥10, and ≥15 mmHg was 34.64%, 9.77%, and 4.44%, respectively. Systolic IABPD ≥15 mmHg was associated with higher systolic and diastolic BP, poor glycemic control, and higher prevalence of albuminuria. Diabetic patients with systolic IABPD ≥5, ≥10, and ≥15 mmHg showed an increased risk of DR (adjusted odds ratio [OR] 1.51 [95% confidence interval (CI) 1.03-2.22], OR 1.82 [95% CI 1.00-3.25], and OR 2.32 [95% CI 1.01-5.31], respectively) after adjustment. Even with adjustment of the mean systolic BP ≥140 mmHg, systolic IABPD ≥5, ≥10, and ≥15 mmHg showed increased risk of DR. Conclusion: The association between IABPD with the presence of DR emerged even for systolic IABPD ≥ 5 mmHg without interaction of systolic BP. Systolic IABPD should be considered as surrogate markers for retinal vascular complications in patients with type 2 diabetes.