Skeletal muscle extracellular matrix (ECM) is the microenvironment for muscle cells to survive and function. Changes in ECM components and structure directly affect the activity and function of muscle cells. Pathological remodeling occurs to skeletal muscle ECM in insulin resistance, including collagen deposition, hyaluronan accumulation, activation of membrane protein integrin signaling path-way, and the imbalance of matrix metalloproteinases and tissue inhibitors of metalloproteinases, while all those would impair the tissue insu-lin sensitivity.