Background <p>Diabetes mellitus has become an important public health problem because of its increasing incidence. Pancreatic fat deposition leads to beta cell dysfunction and has been identified as a major contributor to the development of T2DM.</p> Objective <p>This study quantified pancreatic fat by magnetic resonance (MR) image and examined its association with T2DM in a defined cohort.</p> Methods <p>Seventy-four patients with type 2 diabetes (T2DM) and 74 patients with normal glucose tolerance were included in this retrospective observational study. Participants were chosen based on clearly defined inclusion (≥ 18 years, complete treatment data, no pancreatitis or pancreatic surgery, and acceptable MR image quality) and exclusion (type 1 diabetes history, systemic diseases confounding results, and liver/pancreatic surgery) criteria. Pancreatic fat deposition in both groups was measured by MR imaging.</p> Results <p>Fasting blood glucose (FBG) and triglycerides (TG) levels were significantly higher, and high-density lipoprotein (HDL) levels were significantly lower in the T2DM group compared to participants in the control group. The fat content of the head, body, and tail of the pancreas was higher in T2DM patients compared to controls. In addition, compared to controls, T2DM patients had a smaller subcutaneous fat area at the L2/3 vertebral space and a larger visceral fat area. Logistic regression analysis indicated that FBG, TG, visceral fat area, and fat content in the head and tail of the pancreas were significant risk factors for T2DM.</p> Conclusion <p>MR quantification is a valid and non-invasive approach to measure pancreatic fat deposition. Its sensitivity in detecting differences in fat depots between T2DM and non-diabetic participants establishes it as a valid means for the early detection of pancreatic fat measures, as a putative clinical risk stratification tool, and as a tool for directing preventative lifestyle interventions.</p>