Background: The incidence of chronic limb-threatening ischemia in diabetic patients is increasing. Diabetes is a well-known risk factor for peripheral arterial disease (PAD), and subsequently diabetic patients are at an increased risk of amputation and mortality compared with non-diabetic patients with PAD. Aim: to evaluate primary patency, limb salvage, major adverse limb events (MALE), and the impact of glycemic control and vitamin K supplementation in diabetic patients undergoing infra-popliteal balloon angioplasty for CLI. Patients and methods: This was retrospective analysis of prospective collected data from August 2022 to August 2024 at vascular surgery department, at vascular surgery and cardiothoracic surgery center, faculty of medicine, Mansoura university, Mansoura, Egypt. Patients were grouped by fasting blood glucose (FBG <144 vs. ≥144 mg/dl), HbA1c (<6.6% vs. >6.6%), and vitamin K use (90 mcg Menaquinone-7 daily vs. none). Results: Controlled FBG (<144 mg/dl) and HbA1c (<6.6%) were associated with higher primary patency (96.1% vs. 19.2% at 1 year, p<0.001; 97.6% vs. 29.5%, p<0.001) and no MALE or amputations (p<0.001). Vitamin K supplementation improved 6-month patency (93.3% vs. 70.8%, p=0.027) and reduced amputations (6.7% vs. 29.2%, p=0.027). Triple-vessel angioplasty reduced MALE risk (p=0.031). Conclusion: Enhanced glycemic control and vitamin K supplementation improve outcomes in diabetic CLI patients undergoing infra-popliteal angioplasty, reducing MALE and amputation rates.