FREQUENCY OF METABOLIC SYNDROME IN TYPE 2 DIABETES AND ITS RELATIONSHIP WITH INSULIN RESISTANCE

Authors

  • Shahid Ahmed
  • Syed Azhar Ahmed
  • Nadir Ali

Abstract

Background: The metabolic syndrome is a cluster of various cardiovascular disease riskfactors: diabetes and pre-diabetes, abdominal obesity, hyperlipidaemia and high blood pressure.People with metabolic syndrome are twice as likely to die from and three times as likely to havea heart attack or stroke compared with people without the syndrome. The objective of the studywas to observe the frequency of metabolic syndrome (MetS) in patients with type 2 diabetesmellitus and study the relationship of insulin resistance with the metabolic syndrome and itsdifferent clinical parameters. Methods: The study was conducted at Combined MilitaryHospital, Malir, in about six months. Hundred and fifty-five patients with type 2 diabetes wereincluded in the study, who were diagnosed after 25 years of age. All those suffering from anyliver disease, non diabetic renal disease, thyroid hormonal disorder, advanced cardiac diseaseand cancers were excluded from the study. Insulin resistance was measured using homeostaticmodel assessment of insulin resistance (HOMA-IR) and International Diabetes Federation (IDF)criteria were used to diagnose metabolic syndrome. Results: Among 155 type 2 diabeticpatients, 66.5% were having metabolic syndrome (MetS) according to IDF criteria. Thisfrequency was significantly higher in women (84.7%) as compared to men (44.3%). Differenceof means of HOMA-IR (Insulin resistance) in MetS present and MetS absent cases wasstatistically significant in men (p=0.02) but not in women (p=0.57), when compared throughindependent sample t-test. Insulin resistance (HOMA-IR) was not significantly correlated withwaist circumference (r=0.24), BMI (r=0.16), triglycerides (r=0.22), HDL cholesterol (r=0.18)and HbA1c (r=0.35) but showed moderate correlation with fasting plasma glucose (r=0.44).Among 39 patients belonging to the 4th quartile of HOMA-IR, i.e., the most insulin resistantpeople, 79% patients had MetS according to IDF criteria, and 21% patients did not have MetS.Conclusion: It is concluded that the frequency of MetS is significantly high in patients withtype 2 diabetes. Insulin resistance as measured through HOMA-IR does not show significantcorrelation with clinical parameters of MetS in type 2 diabetics.Keywords: Metabolic syndrome, insulin resistance, HOMA-IR, IDF criteria

References

Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M,

Cardiovascular morbidity and mortality associated with the

metabolic syndrome. Diabetes Care 2001;24:683–9.

Stern MP, Williams K, Gonzalez-Villalpando C, Hunt KJ,

Haffner SM. Does the metabolic syndrome improve

identification of individuals at risk of type 2 diabetes and/or

cardiovascular disease? Diabetes Care 2004;27:2676-81

DeFronzo, RA, Ferrannini, E. Insulin resistance. A

multifaceted syndrome responsible for NIDDM, obesity,

hypertension, dyslipidemia, and atherosclerotic cardiovascular

disease. Diabetes Care 1991;14:173–94.

Lindsay, RS, Howard, BV. Cardiovascular risk associated with

the metabolic syndrome. Curr Diab Rep 2004;4:63–8.

Koh KK, Han SH, Quon MJ. Inflammatory markers and the

metabolic syndrome insights from therapeutic interventions. J

Am Coll Cardiol 2005; 46:1978.

Conus F, Allison DB, Rabasa-Lhoret R, St-Onge M, St-Pierre

DH, Tremblay-Lebeau A, et al. Metabolic and behavioral

characteristics of metabolically obese but normal-weight

women. J Clin Endocrinol Metab 2004; 89:5013–20.

Reaven G. The metabolic syndrome or the insulin resistance

syndrome? Different names, different concepts, and different

goals. Endocrinol Metab Clinics North Am 2004;33:283–303.

Meigs, JB. Invited commentary: insulin resistance syndrome?

Syndrome X? Multiple metabolic syndrome? A syndrome at

all? Factor analysis reveals patterns in the fabric of correlated

metabolic risk factors. Am J Epidemiol 2000;152:908–11.

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH,

Franklin BA, et al. Diagnosis and management of the

metabolic syndrome: an American Heart Association/National

Heart, Lung, and Blood Institute Scientific Statement.

Circulation 2005; 112:2735–52.

Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force

Consensus Group. The metabolic syndrome--a new worldwide

definition. Lancet 2005;366:1059–62.

Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S,

Vijay V. Metabolic syndrome in urban Asian Indian adults - a

population study using modified ATP III criteria. Diabetes Res

Clin Pract 2003;60:199–204.

Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence

of metabolic syndrome using WHO, ATPIII and IDF

definitions in Asian Indians: the Chennai Urban Rural

Epidemiology Study (CURES-34). Diabetes Metab Res Rev

;23:127–34.

Reddy KS, Yusuf S. Emerging epidemic of cardiovascular

disease in developing countries. Circulation 1998;97:596–601.

Matthews DR, Hosker JP, Naylor BA, Treacher DF, Turner

RC. Homeostasis model assessment: insulin resistance and

beta-cell function from fasting plasma glucose and insulin

concentrations in man. Diabetologia 1985;28:412–419.

Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new

world-wide definition. A Consensus Statement from the

International Diabetes Federation. Diabet Med 2006;23:469–80.

Misra A, Misra R, Wijesuriya M. The metabolic syndrome in

South Asians. In: Mohan V, HR Rao G, editors. Type 2

diabetes in South Asians: epidemiology, risk factors and

prevention. New Delhi: Jaypee Bros; 2006. p.76–95.

Basit A, Shera S. Prevalence of metabolic syndrome in

Pakistan. Metabol Syndr Relat Disord 2008;6:171–5.

Lu B, Yang Y, Song X, Dong X, Zhang Z, Zhou L. An

evaluation of the International Diabetes Federation definition

of metabolic syndrome in Chinese patients older than 30 years

and diagnosed with type 2 diabetes mellitus. Metabolism

;55:1088–96.

J Ayub Med Coll Abbottabad 2010;22(1)

http://www.ayubmed.edu.pk/JAMC/PAST/22-1/Shahid.pdf 27

Koehler C, Ott P, Benke I, Hanefeld M. Comparison of the

Prevalence of the Metabolic Syndrome by WHO,

AHA/NHLBI, and IDF Definitions in a German Population

with Type 2 Diabetes: The Diabetes in Germany (DIG) Study.

Horm Metab Res 2007;39:632–5.

Fawwad A, Qasim R, Hydrie ZI, Basit A, Miyan Z, Gul A.

Correlation of fasting insulin resistance indices with clinical

parameters of metabolic syndrome in type 2 diabetic subjects.

Pak J Med Sci 2006;22:433–7.

Alexander CM, Landsman PB, Teutsch SM, Haffner SM.

Third National Health and Nutrition Examination Survey

(NHANES III); National Cholesterol Education Program

(NCEP). NCEP-defined metabolic syndrome, diabetes, and

prevalence of coronary heart disease among NHANES III

participants age 50 years and older. Diabetes 2003;52:1210–14.

Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff

BM, Brunzell JD, et al. Intra-abdominal fat is a major

determinant of the National Cholesterol Education Program

Adult Treatment Panel III criteria for the metabolic syndrome.

Diabetes 2004;53:2087–94.

Reaven GM. Banting lecture 1988. Role of insulin resistance in

human disease. Diabetes 1988;37:1595–607.

Ferrannini E, Haffner SM, Mitchell BD, Stern MP.

Hyperinsulinemia: the key feature of a cardiovascular and

metabolic syndrome. Diabetologia 1991;34:416–422.

Published

2010-06-01

Issue

Vol. 22 No. 1 (2010): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.