Objective This study investigated the correlation between hemoglobin variation index(HGI)and the severity of reti-nopathy and macular edema in patients with type 2 diabetes mellitus(T2DM).Methods A total of 294 T2DM patients were en-rolled.Based on the 2022 International Academy of Ophthalmology diagnostic criteria for diabetic retinopathy(DR),patients were classified into:proliferative DR(PDR),non-PDR(NPDR),and no microangiopathy(NC).DR severity was further categorized as mild NPDR,moderate NPDR,severe NPDR,and PDR.According to the international grading standards for diabetic macular e-dema(DME),patients were categorized as:central involved DME(CI-DME),non-central involved DME(NCI-DME),and no central involved DME(NDME).DME severity:NCI-DME<CI-DME.General clinical data were collected,and HGI differences between groups were analyzed.Results Patients with NPDR and PDR group had significantly higher HGI than those with NC.PDR patients had higher HGI than NPDR patients.Similarly,NCI-DME and CI-DME patients had significantly higher HGI than NDME patients,with CI-DME having the highest HGI.Univariate Logistic regression analysis revealed significant correlations between the presence of DR and T2DM,course of diabetes(P<0.01),body mass index(P=0.01),diastolic blood pressure(P=0.04),HGI(P=0.01),fasting plasma glucose(P=0.04),and HbA1c(P=0.01).Additionally,a significant correlation(P<0.001)was found between HGI and DR severity.Conclusion HGI is closely associated with the severity of both DR And DME in T2DM patients.