This study examines the relationship between fat distribution and diabetes in US adults by sex and race/ethnicity. Using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018, the study analyzed the association between visceral adipose tissue area (VATA), subcutaneous fat area (SFA), and diabetes prevalence. The results showed that VATA was positively associated with diabetes in both sexes and across all racial/ethnic groups except Black females. No statistically significant relationship was found between SFA and diabetes when accounting for VATA, except in White females. The relationship between VATA and diabetes was stronger in White and Hispanic females compared to Black females, while the relationship between SFA and diabetes did not differ between racial/ethnic groups. The study concluded that visceral fat was more strongly associated with diabetes than subcutaneous fat. Additionally, health disparities were observed in sex-specific racial/ethnic groups, highlighting the need for further research. The study used a nationally representative sample and adjusted for demographics and muscle mass. The findings indicate that fat distribution is more important to metabolic health than overall body fat, and that global measures of adiposity hold value primarily as a measure of abdominal adiposity. The study also highlights the need for further research to understand racial/ethnic differences in the relationship between visceral and subcutaneous fat and diabetes.This study examines the relationship between fat distribution and diabetes in US adults by sex and race/ethnicity. Using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018, the study analyzed the association between visceral adipose tissue area (VATA), subcutaneous fat area (SFA), and diabetes prevalence. The results showed that VATA was positively associated with diabetes in both sexes and across all racial/ethnic groups except Black females. No statistically significant relationship was found between SFA and diabetes when accounting for VATA, except in White females. The relationship between VATA and diabetes was stronger in White and Hispanic females compared to Black females, while the relationship between SFA and diabetes did not differ between racial/ethnic groups. The study concluded that visceral fat was more strongly associated with diabetes than subcutaneous fat. Additionally, health disparities were observed in sex-specific racial/ethnic groups, highlighting the need for further research. The study used a nationally representative sample and adjusted for demographics and muscle mass. The findings indicate that fat distribution is more important to metabolic health than overall body fat, and that global measures of adiposity hold value primarily as a measure of abdominal adiposity. The study also highlights the need for further research to understand racial/ethnic differences in the relationship between visceral and subcutaneous fat and diabetes.