The composition of skeletal muscle and adipose tissue plays a pivotal role in the pathogenesis and prognosis of type 2 diabetes mellitus (T2DM). Increased fat mass— particularly visceral adiposity—and reduced muscle mass have been demonstrated to be associated with insulin resistance, impaired glucose metabolism, and an elevated risk of cardiovascular complications. Aims: This study aimed to investigate the differences in muscle–fat ratio and factors associated with glycemic control among groups of patients with T2DM.

A descriptive cross-sectional study was conducted from May to October 2025 at the Outpatient Department of the University Medical Center Ho Chi Minh City – Branch 2. A total of 122 patients with type 2 diabetes mellitus, diagnosed according to the 2024 ADA criteria, were enrolled. Demographic and laboratory data were retrieved from medical records. Body composition was assessed using the InBody 270 analyzer, and all data were analyzed with STATA version 17.0.

We observed that the proportion of patients with obese T2DM (61.48%) was higher than that of those with lean T2DM (38.52%). Significant differences in the muscle-to-fat ratio, body mass index (BMI), waist circumference, and high-density lipoprotein cholesterol (HDL-C) were found between the two groups (p < 0.05). The muscle-to-fat ratio was significantly associated with age and HDL-C (p < 0.05). A multivariable logistic regression model predicting the likelihood of achieving glycemic control (HbA1c < 7%) based on age, sex, duration of diabetes, HDL-C, and the muscle-to-fat ratio yielded an area under the receiver operating characteristic curve (AUC) of 0.7291 (95% confidence interval [CI]: 0.7007–0.7819; p < 0.001), indicating fair discriminative ability to distinguish between patients who did and did not achieve the HbA1c target. In this study, age, duration of diabetes, HDL-C, and the muscle-to-fat ratio were independently associated with glycemic control.

Significant differences in the muscle-to-fat ratio, body mass index (BMI), waist circumference, and high-density lipoprotein cholesterol (HDL-C) were observed between patients with obese T2DM and those with lean T2DM. The muscle-to-fat ratio emerged as an important independent factor associated with glycemic control.