AIM: This study evaluated the association of Heart rate variability (HRV) measurements with diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes. METHODS: This study included 102 Korean subjects with type 2 diabetes. The Michigan neuropathy screening instrument (MNSI) questionnaire score, the MNSI examination score (MNSIES) and the total symptom score were examined for DPN evaluation. Noninvasive HRV measurements were performed using photoelectric plethysmography. Patients with a MNSIES鈥?鈥? were considered to have DPN. RESULTS: The MNSIES showed significant negative associations with the high frequency (HF) (r鈥?鈥?0.212, p鈥?鈥?.033) and low frequency (LF) (r鈥?鈥?0.286, p鈥?鈥?.004) powers. Multiple linear regression analysis revealed that only HF power maintained a significant negative association with the MNSIES (beta鈥?鈥?0.184; 95% CI -0.365 to -0.003; p鈥?鈥?.047), after controlling for significant related confounders, with HRV parameters in male patients with type 2 diabetes. The HF (p鈥?鈥?.010) and LF (p鈥?鈥?.025) powers differed significantly between male patients without and those with DPN according to the MNSIES. CONCLUSIONS: This study revealed a negative association of DPN, as assessed by the MNSIES, with HF power in male patients with type 2 diabetes. DPN defined by foot examination was predictive of cardiac autonomic neuropathy.