Sarcopenia is an underrecognized yet clinically significant complication in individuals with type 2 diabetes mellitus (T2DM), influenced in part by adverse alterations in body composition such as myosteatosis. This study examined sex-specific associations between regional fat-to-lean ratios, measured by dual-energy X-ray absorptiometry (DXA), and sarcopenia status in Taiwanese adults with T2DM. A cross-sectional study was conducted in 103 adults with T2DM (60 females, 43 males) aged 50–80 years.