Background This study aimed to evaluate reciprocal interaction between hepatic steatosis (HS) and type 2 diabetes (T2D) through comparative analysis of anti-diabetic treatment, glycemic control, and renal and hepatic function in T2D patients with versus without concomitant HS. Methods A total of 102 T2D patients were included in this cross-sectional single-center study, and patients were divided into two groups including those with HS (n = 58) and those without HS (n = 44). Data on patient demographics, current anti-diabetic treatment, and serum levels for fasting blood glucose (FBG), HbA1c (%), urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lipids were recorded. Results Diabetic patients with HS had younger age (59.6 +/- 10.5 vs. 63.5 +/- 14.5 years, p = 0.034) and lower serum urea levels (28.5 (3-61) vs. 39 (14-138), p = 0.012). Metformin (74.1% in patients with HS, 65.9% in patients without HS) was the most frequent anti-diabetic treatment in both groups with similar rate of glycemic control (HbA1c < 7%, 39.7%, and 40.9% of patients, respectively). HbA1c levels were positively correlated with serum urea (r = 0.308, p = 0.042), creatinine (r = 0.306, p = 0.044), and triglyceride (r = 0.358, p = 0.017) levels only in patients without HS. In patients with HS, no significant difference was noted in ALT and AST levels with respect to anti-diabetic regimen. Logistic regression analysis revealed that the presence of proteinuria (OR, 0.327, 95% CI 0.12 to 0.91, p = 0.032) was associated with decreased likelihood of HS in T2D patients. Conclusion In conclusion, our findings revealed no increase in the risk of poor glycemic control, dyslipidemia, or nephropathy pertaining to concomitant HS in T2D patients, as well as no difference in ongoing anti-diabetic treatments in terms of serum ALT and AST levels.