Objective: To investigate the correlation between visceral fat area, serum metabolic markers, and the severity of white matter hyperintensities (WMH) in patients with type 2 diabetes mellitus (T2DM). Methods: 79 patients with type 2 diabetes mellitus (T2DM) who underwent abdominal computed tomography (CT) and brain magnetic resonance imaging (MRI) scans were selected as the research subjects. They were divided into two groups: a no/mild WMH group (n=48) and a moderate/severe WMH group (n=31), based on Fazekas scores. The visceral fat area was measured on CT images. Clinical data and serological markers, including homocysteine and uric acid, were collected. Univariate and multivariate Logistic regression analyses were performed to identify independent factors associated with WMH severity. Results: Univariate analysis revealed that age, visceral fat area, homocysteine, and uric acid were associated with WMH severity (P<0.05). Multivariate analysis (model incorporating these four variables, all variance inflation factors < 5) identified visceral fat area, age, and homocysteine as independent risk factors for moderate/severe WMH (P<0.05). Conclusion: In T2DM patients, greater visceral fat area, older age, and higher homocysteine levels are independent risk factors for increased WMH severity. Monitoring visceral fat and homocysteine may help identify high-risk populations for cerebral small vessel disease.