China is the largest cotton-producing nation in the world with total annual production of 4.4 million metric tons and unit lint yield of 800 kg/hectare. Insect pests constitute a major limiting factor to cotton production with estimated annual losses of over 15%. Insecticide resistance has become the most difficult problem in controlling cotton insect pests with eight species reported to have developed resistance to one or more conventional insecticides. In this paper, incidence, status, measuring and monitoring of insecticide resistance of cotton insect pests are reviewed. Based on analyses of causes and mechanisms of resistance, three strategies (ecological, biological and chemical) of resistance management are discussed with their effects demonstrated. Further development of insecticide resistance management systems is suggested.