Objective To investigate the risk factors for nonalcoholic fatty liver disease (NAFLD) and fatty liver fibrosis in type 2 diabetes mellitus (T2DM) inpatients. Methods A total of 1 109 T2DM patients hospitalized in our department from May 2008 to December 2011 were subjected in the study. Their clinical data, such as medical history, results of laboratory examinations, and hepatic ultrasonograms were collected and analyzed. They were divided into T2DM group and T2DM&NAFLD group according to the ultrasonic tomography results. Then the latter group was further assigned into non-fibrosis subgroup, uncertain subgroup and fibrosis subgroup according to NAFLD fibrosis score (＜-1.455, from -1.455 to 0.676, or ＞0.676). Results (1) Body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), serum uric acid (UA), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPBG), fasting C peptide (FCP), and HOMA-C peptide were significantly higher (P＜0.05 or P＜0.01), while age, T2DM course, and high density lipoprotein cholestererol (HDL-C) were significantly lower in T2DM&NAFLD group than in T2DM group (P＜0.01). (2) Logistic analysis showed that BMI [odds ratio (OR)=1.325, 95% CI=1.249?1.406], ALT (OR=1.025, 95% CI=1.013?1.038), and TG (OR=1.283, 95% CI=1.105?1.490) were the major risk factors for NAFLD in T2DM patients, while HDL-C (OR=0.532, 95% CI=0.286?0.989) was the protective factor. (3) Among the patients with NAFLD, the prevalence of fatty liver fibrosis was 13.4%. The age, diabetic course, BMI, WC, HC, systolic blood pressure (SBP), AST/ALT, GGT and hemoglobin Alc (HbA1c) were significantly higher (P＜0.01), but the ALT, albumin (ALB), TG and platelet (Plt) were significantly lower in the fibrosis subgroup than in the non-fibrosis and uncertain subgroups (P＜0.01 or P＜0.05). (4) Ordinal logistic regression indicated that the age, BMI, ALB, AST/ALT and Plt were the risk factors for fatty liver fibrosis. Conclusion Higher prevalence of coexisting NAFLD is found in the T2DM patients, which is closely associated with BMI, TG, ALT and HDL-C. What’s more, the T2DM patients with coexisting NAFLD are prone to developing liver fibrosis, which is closely associated with the age, BMI, AST/ALT, ALB and Plt.