A cross-sectional study of 300 diabetic adults at a Ugandan hospital revealed peripheral artery disease (PAD) prevalence of 42.3% using ankle-brachial index measurements, with 15.8% classified as severe cases. This finding represents one of the highest documented PAD rates among diabetic populations globally. The prevalence significantly exceeds rates typically reported in Western populations, where PAD affects 15-25% of diabetic patients. Despite high rates of established risk factors including elevated LDL cholesterol (60%), physical inactivity (54%), and poor fruit intake (68%), the study found no significant associations between traditional cardiovascular risk factors and PAD development. This unexpected finding suggests unique population-specific mechanisms may be driving vascular disease in sub-Saharan Africa, potentially including chronic inflammatory processes or genetic factors not captured in Western research. The results highlight critical healthcare gaps in low-resource settings where PAD screening remains uncommon despite its high prevalence. However, this preprint study awaits peer review and faces limitations including its cross-sectional design, single-center setting, and relatively small sample size. The findings underscore urgent need for routine PAD screening protocols in diabetic care across sub-Saharan Africa and warrant larger prospective studies incorporating inflammatory biomarkers.