Abstract:ObjectiveTo explore the correlation between serum uric acid-to-creatinine ratio(SUA/SCr) and metabolic syndrome(MS) and its components in patients with type 2 diabetes mellitus(T2DM). Methods A retrospective study was conducted on 586 patients with T2DM admitted to Nanjing Jiangbei Hospital from October 2020 to July 2022, According to the quartile of SUA/SCr levels, they were divided into four groups: Q1 group (n=147) with＜3.54, Q2 group (n=146) with 3.54 to ＜4.35, Q3 group (n=147) with 4.35 to ＜5.49 and Q4 group (n=146) with ≥ 5.49. The correlations bewteen SUA/SCr and MS and its components (overweight and/or obesity, hypertension, dyslipidemia) were analyzed. Results As SUA/SCr increased, patients age, T2DM course, HDL-C and SCr levels decreased, while male proportion and BMI, DBP, TC, TG, SUA levels, as well as the prevalence of MS and its components (overweight and/or obesity, dyslipidemia) increased (P＜0.05). Pearson correlation analysis showed that SUA/SCr was positively correlated with BMI, DBP and TG ,and negatively correlated with HDL-C and HbA1c (P＜0.05) after adjusting for age, sex, duration of disease, smoking and drinking. Logistic regression analysis showed that after adjusting for age, sex, duration of disease, smoking and drinking, compared with Q1 group, the risk of MS in Q2 group, Q3 group and Q4 group increased significantly by 85% (OR=1.85), 70% (OR=1.70) and 313%（OR=4.13), respectively,with statistical significances (P＜0.01).The risk of overweight and/or obesity, hypertension and dyslipidemia also significantly increased.There was a dose-response relationship between SUA/SCr and the risk of MS, and the risk of MS increased by 31% when SUA/SCr increased by one unit (OR=1.31, P＜0.05). Conclusion The increase of SUA/SCr level in T2DM patients is closely related to the increased risk of MS and its components. SUA/SCr can be used as an early biomarker of MS, which provides a new scientific basis for the prevention, treatment and reversal of MS.