Background: Type 2 Diabetes Mellitus (T2DM) is characterized by complex metabolic abnormalities, including dyslipidemia and micronutrient imbalances, which contribute significantly to the development of microvascular complications such as diabetic nephropathy. While magnesium is essential for insulin signalling, glucose metabolism, and cellular homeostasis, serum very-low-density lipoprotein (VLDL) indicates disruptions in lipid metabolism. The ratio of Serum VLDL to Serum magnesium has emerged as a potential composite biomarker integrating these metabolic alterations.Methods:A hospital-based cross-sectional observational study was conducted over a period of 18 months at a tertiary care teaching hospital. A total of 103 patients with T2DM aged between 18 and 80 years were enrolled using convenience sampling. Clinical history, fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated haemoglobin (HbA1c), lipid profile, renal function tests, and serum magnesium levels were among the laboratory values that were documented. For each subject, the serum VLDL–magnesium ratio was computed. SPSS version 28 was used for statistical analysis. The Chi-square test, independent t-test, one-way ANOVA, and Pearson correlation coefficient were used to assess correlations between variables. The predictive value of the ratio for diabetic nephropathy was evaluated using receiver operating characteristic (ROC) curve analysis.Results:The Serum VLDL–magnesium ratio showed significant variation across different levels of glycemic control and nephropathy status. Higher ratios were significantly associated with elevated HbA1c levels, indicating poorer glycemic control. Patients with diabetic nephropathy demonstrated significantly higher VLDL–magnesium ratios compared to those without nephropathy. The ratio also exhibited significant correlations with renal function parameters. ROC analysis demonstrated its potential utility in predicting diabetic nephropathy, suggesting that elevated VLDL levels combined with reduced magnesium concentrations reflect increased metabolic stress and a higher risk of renal complications.Conclusion:The Serum VLDL–magnesium ratio is a promising composite biomarker in patients with T2DM. It demonstrates significant associations with glycemic control and diabetic nephropathy and may serve as a simple, cost-effective tool for early risk stratification and identification of patients at increased risk of renal complications, complementing conventional biochemical markers.