PLOS ONE Medicine&Health

The relationship between METS-IR and the risk of diabetes incidence in rural adults in China: A retrospective cohort study based on dynamic population

by Zihao Li, Xuejiao Chen, Wanli Hu, Gefei Li, Xiaoke Zhang, Datian Gao, Haiyun Gao, Songhe Shi

To evaluate the longitudinal association between the Metabolic Score for Insulin Resistance (METS-IR) and the risk of diabetes mellitus in rural Chinese adults.

This retrospective cohort study included 53,120 participants aged ≥18 years from 2018 to 2023. Participants were stratified by quartiles of the METS-IR metrics. Cox proportional hazards models assessed the association between METS-IR and incident diabetes. Restricted cubic spline (RCS) models examined nonlinear trends. Subgroup analysis, interaction tests, and multiple sensitivity analyses were performed. Predictive ability was evaluated using time-dependent receiver operating characteristic (ROC) curves.

During 176,413.4 person-years of follow-up (median 3.83 years), 14,397 participants developed diabetes. After multifactorial adjustment, METS-IR was significantly and positively associated with diabetes onset (hazard ratio (HR)=1.094,95% confidence interval (CI): 1.076–1.112, P  Conclusion

METS-IR is significantly correlated with the onset of diabetes, and the relationship is nonlinear. While it demonstrates limited discriminatory performance as a standalone screening tool, it remains suitable for initial risk stratification in primary health care institutions with limited resources.