Type 2 diabetes mellitus (DM2) increases the risk of developing sarcopenia through the presence of oxidative stress and chronic inflammation. Bilirubin has been shown to have antioxidant activity. Objective: to investigate the relationship between bilirubin and sarcopenia in elderly patients with type 2 diabetes. Materials and methods of the study: 251 patients (mean age 65.76 ± 2.89 years) with DM2 took part in the study. All participants were determined by the body mass index; systolic blood pressure (SBP) and diastolic blood pressure (DBP); fasting blood glucose; glycated hemoglobin (HbA1c); C-peptide on an empty stomach; total cholesterol; triglycerides; ALAT; ASAT; creatinine; total, direct, indirect bilirubin. Body composition was studied using bioimpedance analysis. Results: Men and women with sarcopenia were older (p age, SBP, HbA1c, HOMA2-IR, triglycerides, total cholesterol, eGFR, smoking, and proportion of fat mass (OR = 0.243, p = 0.009). Conclusion: Total and indirect bilirubin are significantly positively associated with IASMI in men with DM2. The higher quartile of indirect bilirubin is associated with a low odds ratio for the risk of developing sarcopenia in men, which may suggest a protective role for indirect bilirubin in protecting against sarcopenia. Further research is needed on the relationship between serum bilirubin concentration and sarcopenia in patients with DM2.