Purpose <p>Global prevalence of type 2 diabetes mellitus (T2DM) continues to rise. This systematic review assessed the relationship between dual-energy x-ray absorptiometry (DXA) body composition measures and risk of T2DM.</p> Methods <p>Ovid MEDLINE, Embase, The Cochrane Library, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews databases were searched. The review adhered to the PRISMA guidelines and employed the GRADE approach. The registration ID for this study in PROSPERO is CRD42023434571.</p> Results <p>Among 3,140 papers retrieved, 9 cohort studies (59,276 individuals) were included in the analysis. Of the results that could be pooled, whole-body fat % (HR: 1.38, 95% CI: 1.32 to 1.44), trunk fat mass (HR: 1.57, 95% CI: 1.49 to 1.65), and trunk fat % (HR: 1.61, 95% CI: 1.25 to 2.07), were associated with incident T2DM in women. No fat mass measures could be pooled for men. Lean mass measures were not statistically associated with incident T2DM in women or men.</p> Conclusion <p>There is an association between DXA fat measures and incident T2DM in women and there may be an association between DXA fat measures and incident T2DM in men as well. Further high-quality investigations are required to validate these findings.</p>