The present study indicated positive associations between serum FGF23 levels and FGF23/α-klotho ratio with T2DM and a negative relationship between α-klotho with T2DM, and the results showed that serum FGF23 and FGF23/α-klotho ratio were both positively associated with atherosclerosis in individuals with T2DM while α-klotho was inversely correlated, postulating that FGF23 elevations and α-klotho reductions may influence the development or progression of atherosclerosis in T2DM patients. Here, KL is linked to atherosclerosis.