Background <p>Arterial stiffness is a risk factor for cardiovascular disease (CVD). There is an interaction effect between arterial stiffness and diabetes and may increase the risk of CVD. It is important to find a sensitive biomarker to estimate the risk of arterial stiffness in Type 2 diabetes mellitus (T2DM).</p> Methods <p>Participants with type 2 diabetes mellites registered at the Metabolic management center (MMC) of Beijing Luhe Hospital. The association between METS-VF and the progression of arterial stiffness (AS) was evaluated using a logistical regression model, and the odds ratio (OR) and 95% confidence interval (CI) were reported and visualizing the risk of arterial stiffness by drawing restricted cubic splines. The trajectory of the metabolic score for visceral Fat (METS-VF) was fitted with the latent class mixture model (LCMM). Moreover, the Cross-lagged panel model was performed to detect the bidirectional cross-lagged associations between METS-VF and brachial-ankle pulse wave velocity (baPWV).</p> Results <p>A total of 701 participants enrolled in the procedure of data analysis. The OR (95%CI) of METS-VF on arterial stiffness progression was 1.54 (1.02, 2.36). We identified three discrete trajectories of METS-VF, the ORs (95%CI) in three trajectories were 1.00 (reference), 1.56 (1.02,2.40), 3.33 (1.65, 6.80), respectively. And there were significant bidirectional cross-lagged associations between METS-VF and baPWV after adjusting for confounding factors, β₁ and β₂ were 0.025 (95%CI:0.006,0.045, <i>P</i> = 0.011) and 0.211 (95%:0.109,0.312, <i>P</i> &lt; 0.001), respectively.</p> Conclusions <p>There was a causal relationship between METS-VF and the progression of arterial stiffness in T2DM. The series of results provided high-quality evidence that controlling METS-VF may affect the progression of arterial stiffness in T2DM.</p> Clinical trial number <p>Not applicable.</p>