Background: Recent studies on ghrelin in type 2 diabetes mellitus and its interactions with insulin are controversial. Clarifying such hormonal interplay in type 2 diabetes could be helpful in control and treatment of the disease. Aim: to study the serum level of ghrelin in patients with type 2 diabetes mellitus, show the effect of glycemic control on ghrelin and study the relationship between ghrelin with components of metabolic syndrome. Methods: 90 subjects were enrolled in two groups, 70 with T2DM and 20 controls. Blood glucose values, HbA1c, insulin, lipid profile, creatinine, liver enzymes and total ghrelin were measured. HOMA-IR and eGFR were calculated. Results: Ghrelin was negatively correlated with BMI, WC, SBP, DBP, FBG, PPBG, triglyceride, total cholesterol, LDL-C, HbA1c, insulin, HOMA-IR, UACR and eGFR and positively correlated with HDL-C and creatinine in diabetic group. Ghrelin was significantly decreased in diabetic patients with severe insulin resistance, poor glycemic control and vascular complications. Conclusion: It can be concluded that low ghrelin level is an indicator of adverse consequences in diabetic patients suggesting that ghrelin antagonism may improve β-cell function.