In patients with type 2 diabetes mellitus, low serum creatinine (Cr) to cystatin C (cysC) ratio [CCR] was found to be independently linked with sarcopenia and high plaque score (PS), especially post-adjusting for appendicular skeletal muscle mass (ASM)/body mass index (BMI) and grip strength (GS).

• This study included a total of 1,577 patients with type 2 diabetes, and high PS was defined as PS ≥ 3.

• The lowest tertile group was older; had higher C-reactive protein levels, CIMT, and PS, but lower cysC-based estimated glomerular filtration rate, ASM/BMI, and GS, relative to the highest CCR group.

• Both genders demonstrated positive correlations between CCR and ASM/BMI and GS.

• For high PS, odds ratios and 95% confidence intervals post-adjusting for age and gender were estimated to be 1.22 in the middle and 1.74 in the lowest tertiles, respectively, with those of the lowest tertile remaining significant following further adjusting for multiple confounders.