The fasting serum total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) levels are used to calculate following lipid ratios: TC/ HDL-C, TG/HDL-C, and LDL-C/HDL-C. Cholesterol retention fraction (CRF), non-HDL-C, LDL-C, TG and waist circumference (WC) one considered as markers for the identification of individuals with an increased risk for cardiovascular diseases (CVD). These individuals frequently show insulin resistance as well. We analyzed the association of lipoprotein ratios with the homeostasis model assessment of insulin resistance (HOMA-IR). Type 2 diabetes mellitus (T2D) patients (92) and 40 age match healthy controls were randomized from the Tapho Primary Health Care Unit and the area in the same district. The HOMA-IR was used to calculate for insulin resistance. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratios markers. All lipoprotein ratios, lipid profile, blood pressure, and WC were significantly higher in T2D patients as compared to healthy controls (P<0.05). TC/HDL-C ratio, TG/HDL-C ratio, non-HDL-C, WC, TG, and TC were significantly correlated with HOMA-IR (P<0.05) as obtained by Spearman correlation analysis. The largest AUC of the ROC curve was obtained with the TC/HDL-C ratio as one parameter. TC/HDL-C ratio, TG/HDL-C, ratio, Non-HDL-C, WC, TG, and TC can be used as the markers of insulin resistance and CVD risk in T2D patients.