This study aimed to determine if baseline VAI, as a marker of systemic metabolic dysfunction, is associated with resistance to intravitreal anti-VEGF therapy in patients with DME.<h4>Methods</h4>This retrospective cohort study analyzed 298 patients with type 2 diabetes and center-involved DME initiating anti-VEGF therapy between January 2022 and December 2023. The gene discussed is VEGFA; the disease is type 2 diabetes mellitus.