Objective Sex differences in the association of HbA1c and cardiovascular disease (CVD) risk remain controversial. We examined CVD risk profile in both HbA1c-defined diabetic and nondiabetic men and women.Methods We conducted a cross-sectional analysis of 7139 Chinese adults using data from the China Health and Nutrition Survey 2009.Results HbA1c-defined nondiabetic men have a more favorable CVD risk profile than female counterparts. However, HbA1c-defined diabetic men have higher levels of triglyceride, low-density lipoprotein (LDL)-cholesterol, and triglyceride/high-density lipoprotein (HDL)-cholesterol and lower levels of HDL-cholesterol, be more visceral obese as indicated by visceral adiposity index (VAI) and lipid accumulation product (LAP), and more insulin resistant as assessed by the triglycerides and glucose index (TyG) than HbA1c-defined diabetic women. Furthermore, HbA1c-defined diabetic men showed greater relative differences in ferritin than diabetic women when compared with their nondiabetic counterparts. Statistically significant sex by HbA1c-defined diabetes status interactions were observed for triglyceride, LDL-cholesterol, HDL-cholesterol, triglyceride/HDL cholesterol, VAI, LAP, TyG, and ferritin (all ps<0.05). Consideration of VAI or homeostasis model assessment of insulin resistance or both failed to eliminate the sex differences in the associations between diabetes and these CVD risk factors.Conclusions Men who progressed from HbA1c-defined nondiabetes to HbA1c-defined diabetes have greater metabolic deteriorations and put on more visceral adiposity than women.Key messagesHbA1c-defined nondiabetic men have a more favorable CVD risk profile than female counterparts.Men have to undergo a greater metabolic deterioration to develop HbA1c-defined diabetes than do women.Men have to put on more visceral adiposity to develop HbA1c-defined diabetes than do women.