Objective To explore the relationship between different surrogate markers of insulin resistance (IR) Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), metabolic score for insulin resistance (METS-IR), metabolic score for visceral fat (METS-VF), triglyceride-glucose index (TyG) and the incidence risk of type 2 diabetes mellitus (T2DM) among the middle-aged and elderly people in China.

Methods A total of 5, 871 middle-aged and elderly individuals over 45 years old who participated in the China Health and Retirement Longitudinal Study from 2011 to 2015 were included as the research subjects. Logistic regression analysis was used to evaluate the association between different surrogate markers of IR and the incidence risk of T2DM. Additionally, the receiver operating characteristic (ROC) curve and the area under the curve (AUC) values were used to evaluate the predictive ability of different markers for the incidence of T2DM among the middle-aged and elderly people.

Results All different surrogate markers of IR were positively correlated with the incidence risk of T2DM. After adjusting for all included covariates, the multivariate logistic regression analysis showed that the population in the highest group of CVAI (OR=1.91, 95% CI: 1.42-2.58), LAP (OR=2.06, 95% CI: 1.54-2.77), METS-IR (OR=2.28, 95% CI: 1.71-3.07), METS-VF (OR=2.01, 95% CI: 1.49-2.72), and TyG (OR= 1.90, 95% CI: 1.41-2.58) had the highest incidence risk of T2DM. The AUC values of the five surrogate markers of IR ranged from 0.565 to 0.582. Among them, the AUC value of METS-VF was the highest (0.582, 95% CI: 0.569-0.595), and its predictive ability was METS-VF > LAP > CVAI > TyG > METS-IR.

Conclusion METS-IR has the strongest association with the incidence risk of T2DM, and METS-VF has the strongest efficacy in predicting the onset of T2DM. Both of them have important clinical significance for the assessment and prediction of the incidence risk of T2DM among the middle-aged and elderly people in China, and can be used as reliable markers for targeted screening.