Objective To investigate the changes of CD4⁺CD25⁺Foxp3⁺ regulatory T cell (Treg) in the peripheral blood of elderly patients with type 2 diabetic peripheral neuropathy (DPN) and its clinical implication. Methods Treg cells were detected by flow cytometry in the peripheral blood of elderly patients with type 2 DPN (DNP group, 20 cases), type 2 diabetes mellitus (T2DM) with no complications (T2DM group, 20 cases) and age-matched healthy volunteers (CON group, 20 cases). The results were statistically analyzed and compared between different groups. Results The numbers of CD4⁺CD25⁺Foxp3⁺ Treg in DPN group and T2DM group were significantly less than that in the healthy volunteers (P<0.05), and the number of Treg cells in DPN group was significantly less than that in T2DM group (P<0.05). The proportion of CD4⁺CD25⁺Foxp3⁺ Treg was negatively associated with Michigan neuropathy screening instrument (MNSI) scores in DPN group, but with no statistical significance; however, the proportion had a significantly negative correlation with Michigan diabetic neuropathy score (r=-0.339, P<0.05). Conclusion The number of CD4⁺CD25⁺Foxp3⁺ Treg is decreased in the peripheral blood of elderly patients with DPN, which may play a role in the development and progression of DPN in elderly patients.