Taking low levels of EV-GDF15 (defined as < 10.48 pg/mL, below the median) plus low levels of serum GDF15 (defined as < 878.50 pg/mL, below the median) as reference, high levels of serum GDF15 (defined as ≥ 878.50 pg/mL, at or above the median) plus low levels of EV-GDF15 increased the risk of T2DM by 3.21-fold (95% CI 1.01–10.16). Here, GDF15 is linked to type 2 diabetes mellitus.