ABSTRACT Aim Visceral adipose tissue ( VAT ) and liver fat ( LF ) are strongly associated with type 2 diabetes. It is not known, however, how diabetes treatment and/or risk factor management modulates the association between VAT , LF and diabetes. The aim was to determine the level of VAT and LF in patients with type 2 diabetes according to their treatment status and achievement of the American Diabetes Association's ( ADA ) diabetes management goals. Methods We performed a cross‐sectional analysis of the baseline data of the International Study of the Prediction of Intra‐Abdominal Adiposity and its Relationship with Cardiometabolic risk/Intra‐Abdominal Adiposity ( INSPIRE ME IAA ), a 3‐year prospective cardiometabolic imaging study conducted in 29 countries. Patients (n = 3991) were divided into four groups: (i) those without type 2 diabetes ( noT2D n = 1003 men, n = 1027 women); (ii) those with type 2 diabetes but not treated with diabetes medications ( T2Dnomeds n = 248 men, n = 198 women); (iii) those with type 2 diabetes and treated with diabetes medications but not yet using insulin ( T2Dmeds ‐ins n = 591 men, n = 484 women) and (iv) those with type 2 diabetes and treated with insulin ( T2Dmeds +ins n = 233 men, n = 207 women). Abdominal and liver adiposity were measured by computed tomography. Results Fewer patients with high VAT or LF achieved the ADA 's goals for high‐density lipoprotein cholesterol ( HDL ‐C) or triglycerides compared to patients with low VAT or LF . Visceral adiposity (p = 0.02 men, p = 0.003 women) and LF (p = 0.0002 men, p = 0.0004 women) increased among patients who met fewer of the ADA treatment criteria, regardless of type 2 diabetes treatment. Conclusion Residual cardiometabolic risk exists among patients with type 2 diabetes characterized by elevated VAT and LF .