Objective To investigate the association between novel evaluation indicators of IR and LEAD in patients with T2DM. Methods A total of 1，164 T2DM patients hospitalized in the Department of Endocrinology and Metabolism of Heze Mudan People's Hospital from January 2022 to April 2025 were enrolled. They were divided into the non-LEAD group （694 cases） and the LEAD group （470 cases） according to the presence of LEAD. General data and biochemical indicators were collected， and the triglyceride-glucose index （TyG）， triglyceride-glucose-body mass index （TyG-BMI）， estimated glucose disposal rate （eGDR）， triglyceride-to-high-density lipoprotein cholesterol ratio （TG/HDL-C）， and Metabolic Syndrome Insulin Resistance index （METS-IR） were calculated. Logistic regression analysis was performed to analyze the influencing factors for the development of LEAD in T2DM patients， as well as the correlation between novel IR assessment indices grouped by different quartiles and the risk of LEAD onset. Receiver operating characteristic （ROC） curve analysis was performed to evaluate the predictive value of these indicators for LEAD. Results Compared with non-LEAD group， the LEAD group had significantly higher TyG， TyG-BMI， TG/HDL-C， and METS-IR， but lower eGDR （all P < 0.05）. Logistic regression analysis showed that TyG， TyG-BMI， and METS-IR were identified as risk factors for the development of LEAD in patients with T2DM， while eGDR was a protective factor against it. After adjusting for confounders， compared with the Q1 group， the Q4 groups of TyG （OR = 3.647， 95%CI： 1.082 ~ 7.972， P < 0.001）， TyG-BMI （OR = 3.027， 95%CI： 1.275 ~ 9.753， P < 0.001）， and METS-IR （OR = 4.032， 95%CI： 1.242 ~ 12.385， P < 0.001） had a significantly increased LEAD risk， while the Q4 group of eGDR had a significantly decreased risk （OR = 0.225， 95%CI： 0.118 ~ 0.429， P < 0.001）. ROC curve analysis showed that METS-IR， TyG， TyG-BMI， and eGDR all exhibit predictive value for LEAD， with areas under the curve being 0.823， 0.758， 0.773， and 0.737， respectively. Subgroup analysis indicated that METS-IR was more strongly correlated with LEAD in subgroups of age ≥ 60 years， disease duration ≥ 5 years， HbA?C ≥ 7.0%， smoking history， and hypertension. Conclusion Elevated levels of TyG， TyG-BMI， and METS-IR， along with decreased levels of eGDR， are associated with an increased risk of LEAD onset in patients with T2DM. METS-IR exhibits high predictive efficacy for the development of LEAD in T2DM patients and may serve as a tool for its screening and risk assessment.