Limited information is available on the effect of hypertriglyceridemia-waist (HTGW) combination and its dynamic status on the risk of type 2 diabetes mellitus (T2DM) in rural China. A cohort of 12,086 participants 18 to 92 years old was retained in this study. Kaplan-Meier analysis yielded the cumulative incidence of T2DM for each phenotype group (based on TG level and waist circumference [WC] at baseline). Cox regression yielded hazard ratios relating HTGW (based on TG level and WC at baseline and follow-up) to risk of developing T2DM. After a median follow-up of 6.0 years (71,432 person-years of follow-up), T2DM developed in 621 participants. For HTGW participants, the incidence of T2DM was 26.4/1000, 20.6/1000, and 21.9/1000 person-years for males, females, and overall, respectively. The adjusted HR for HTGW associated with T2DM was 7.63 (95% CI 4.32-13.49) for males and 7.75 (4.71-12.78) for females. Compared with consistent HTGW, with transformation from baseline HTGW to normal WC and normal triglycerides level at follow-up, the risk of developing T2DM was reduced by 75% and 78% for males and females. HTGW is a major risk factor for T2DM, but the risk could be reduced by improved triglycerides level and WC.