Purpose: This prospective cross-sectional study investigates the relationship between haemoglobin A1c (HbA1c) levels and tissue loss in patients with peripheral artery disease (PAD). We hypothesised higher HbA1c levels, indicative of poor glycaemic control, exacerbate complications such as ulceration, gangrene, and amputation. Understanding this relationship is crucial for managing and preventing severe limb outcomes. Methodology: A cohort of 80 patients diagnosed with PAD were recruited between September 2023 and July 2024. Patients were categorised into four groups based on baseline HbA1c levels: <6%, 6-7%, 7-8%, and >8%. Baseline tissue loss was assessed by clinical examination and patient history. Statistical analyses used prevalence odds ratios to evaluate the association between HbA1c levels and the extent of tissue loss. Results: The study identified a significant positive correlation between elevated HbA1c levels and the severity of tissue loss in patients with PAD. Patients with HbA1c levels >8% exhibited a threefold higher prevalence of severe tissue loss compared to those with levels <6% and 2.5 times higher than those with levels between 6-7%. The intermediate group (HbA1c 7-8%) also demonstrated a higher risk of tissue loss, though to a lesser extent. Additionally, patients with poor glycaemic control experienced more severe occurrences of chronic limb-threatening ischaemia and required more aggressive intervention, including revascularisation procedures and amputation. Conclusion: Increased HbA1c levels are associated with greater tissue loss in patients with PAD, highlighting the importance of stringent glycaemic control. These findings support that maintaining lower HbA1c levels can mitigate the risk of severe tissue loss and improve outcomes for patients with PAD. Future research should focus on interventions to explore the impact of intensive glycaemic control on tissue preservation, quality of life, and overall vascular health in this population.