Not all type 2 diabetes mellitus (T2DM) patients exhibit insulin resistance (IR). Our objective is to identify the most effective sex-specific index for predicting IR in T2DM. This will be achieved through a comparative analysis of the sex-specific attributes of waist to hip circumference ratio (WHR), visceral fat area to hip circumference ratio (VHR), and visceral fat area to subcutaneous fat area ratio (VSR).Receiver operating characteristic curve analysis was conducted to estimate the area under the curve for WHR, VHR, and VSR. Subsequently, logistic regression was employed to analyze the relationship between VHR and IR.There were significant differences between males and females in anthropometric measurements, biochemical data, and obesity prevalence. ROC analysis revealed that the area under the curve (AUC) for predicting male IR was 0.67, 0.71, and 0.62 for WHR, VHR, and VSR, respectively. For females, the AUC values were 0.63, 0.69, and 0.60, respectively. In multivariate logistic regression analysis, adjusting for confounding factors, compared to the lowest tertile of VHR, the odds ratio (OR) of the highest tertile was 2.2 (95% CI: 1.47-3.3, P<0.001) for males and 2.1 (95% CI: 1.24-3.57, P=0.005) for females.VHR emerges as the most reliable predictor of IR risk in individuals with T2DM.© 2024 Cao et al.