Introduction: Type 2 Diabetes Mellitus (T2DM) is associated with various complications, including cognitive impairment, which significantly affects disease management and quality of life. The objective of this study was to evaluate the prevalence and impact of cognitive impairment in T2DM patients using the Montreal Cognitive Assessment (MOCA) scale. Materials and Methods: This cross-sectional study included 446 adults diagnosed with T2DM, enrolled from June 2021 to December 2024. Patients were assessed for cognitive function using the MOCA scale, and data on demographics, diabetes-related variables, and comorbidities were collected. Cognitive impairment was defined as a MOCA score of 26 or below. Results: The study found that 59.6% of participants exhibited cognitive impairment, with 33.6% showing mild, 20.2% moderate, and 5.8% severe impairment. Significant associations were observed between cognitive dysfunction and factors such as poor glycemic control (higher HbA1c levels), longer duration of diabetes, abnormal lipid profiles, and comorbidities including hypertension, dyslipidemia, and neuropathy. Discussion: The findings indicate that cognitive impairment is common in T2DM patients, with multiple diabetes-related and comorbid factors contributing to its progression. These results underscore the importance of routine cognitive screening, particularly for individuals with poor glycemic control and related complications. Conclusion: The study highlights the high prevalence of cognitive impairment in T2DM patients and the critical need for comprehensive care, including cognitive screening and better management of diabetes-related risk factors to prevent cognitive decline.