Anthropometric and metabolic indexes as surrogates of type 2 diabetes risk: a large-scale comparison using QDScore, FINRISK, CANRISK, and TRAQ-D

Background: Early identification of individuals at increased risk of type 2 diabetes mellitus (T2DM) is essential for effective prevention strategies. Although several validated diabetes risk scores are available, their routine application may be limited in large-scale or occupational settings. Simple anthropometric and metabolic indexes may represent practical alternatives for diabetes risk screening. Objective: To evaluate the association and discriminatory performance of four anthropometric and metabolic indexes—body mass index (BMI), waist-to-height ratio (WtHR), triglyceride–glucose (TyG) index, and waist–triglyceride index (WTI)—in relation to high-risk classifications defined by QDScore, FINRISK, CANRISK, and TRAQ-D. Methods: A cross-sectional study was conducted in 383,980 Spanish workers aged 18–69 years without diagnosed diabetes. Anthropometric measurements and fasting biochemical parameters were obtained using standardized protocols. Diabetes risk scores were calculated, and receiver operating characteristic (ROC) curve analyses were performed to assess the ability of each index to identify individuals classified as high risk. Analyses were stratified by sex. Results: Higher values of BMI, WtHR, TyG, and WTI were consistently associated with high-risk classifications across all diabetes risk scores (p < 0.001). BMI and WtHR showed excellent discriminatory performance, particularly in women, with area under the curve (AUC) values exceeding 0.90 for several scores. Metabolic indexes (TyG and WTI) demonstrated moderate but consistent discrimination in both sexes. Conclusions: Simple anthropometric and metabolic indices are closely associated with validated T2DM risk scores and allow for the effective identification of individuals at higher risk within occupational populations. Their simplicity and low cost support their use in population and occupational screening strategies.