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Exp Clin Endocrinol Diabetes 2006; 114(7): 377-383
DOI: 10.1055/s-2006-924319
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Metabolic Syndrome and Prediabetes Identify Overlapping But Not Identical Populations

E. J. Diamantopoulos1 , E. A. Andreadis1 , G. I. Tsourous1 , G. K. Ifanti1 , P. M. Katsanou1 , D. X. Georgiopoulos1 , C. V. Vassilopoulos1 , G. Dimitriadis2 , S. A. Raptis2
  • 14th Department of Internal Medicine and Unit for Vascular Medicine, Evangelismos State General Hospital, Athens, Greece
  • 22nd Department of Internal Medicine, Research Institute and Diabetes Centre, University General Hospital Attikon, Athens, Greece
Further Information

Publication History

Received: August 12, 2005 First decision: March 7, 2006

Accepted: May 29, 2006

Publication Date:
16 August 2006 (online)

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Abstract

Objective: The metabolic syndrome (MetS) is a cluster of risk factors related to cardiovascular disease. Prediabetes, identified by impaired fasting glucose and/or impaired glucose tolerance, may predict future development of diabetes mellitus. However, it is not clear whether MetS and prediabetes represent the same or different clinical entities. This study compares MetS and prediabetes in terms of cardiovascular risk factors and target organ damage. Research Design and Methods: A total of 524 overweight and obese (body mass index, BMI ≥ 27 kg/m2) adults, mean age 53.6 ± 10.3 years, 264 men and 260 women, were studied. All participants underwent a thorough clinical and laboratory evaluation, including an oral glucose tolerance test and insulin measurements. Echocardiography, carotid ultrasonography, and pulse wave analysis were also performed for the detection of target organ damage. NCEP‐ATP III and ADA criteria were used for the diagnosis of MetS and prediabetes. Results: The prevalence of MetS and prediabetes was 38.7 and 25.4 %, respectively. Overall, 129 individuals (24.6 %) had MetS without prediabetes (group M) and another 59 (11.3 %) prediabetes without MetS (group P). Group P had decreased albumin excretion (p = 0.033) and more thickened common carotid intima-media in comparison to group M (p = 0.032). Furthermore, group M was associated with higher C-reactive protein levels. Multiple logistic regression analysis revealed that advanced age (p < 0.0001, OR 1.11, 95 % CI 1.06 - 1.16), low insulin secretion (p < 0.0001, OR 0.05, 95 % CI 0.02 - 0.18 for insulinogenic index), and increased insulin resistance (p = 0.0003, OR 3.22, 95 % CI 1.71 - 6.07 for HOMA‐IR) were associated with group P. Conclusions: Our data demonstrate that MetS and prediabetes have an overlapping pattern. MetS appears to have a more pronounced effect on early renal dysfunction and increased inflammatory activation, while prediabetes tends to be associated with early carotid structural changes. These findings may be due to a different pathophysiologic substrate of these clinical phenotypes in terms of insulin resistance and secretion, as well as to the varying prevalence of cardiovascular risk factors.

Key words

Metabolic syndrome - prediabetes - carotid intima-media thickness - microalbuminuria - CARMOS-Study

References

  • 1 American Diabetes Association . Prediabetes. Clinical Practice Recommendations, 2004.  Diabetes Care. 2004;  27 5-10
    PubMedGoogle Scholar
  • 2 Calle E E, Thun M J, Petrelli J M, Rodriguez C. et al . Body mass index and mortality in a prospective cohort of U.S. adults.  N Engl J Med. 1999;  341 1097-1105
    CrossrefPubMedGoogle Scholar
  • 3 Chobanian A V, Bakris G L, Black H. et al . Seventh Report Of The Joint National Committee On Prevention, Detection, Evaluation, And Treatment Of High Blood Pressure.  Hypertension. 2003;  42 1206-1252
    CrossrefPubMedGoogle Scholar
  • 4 Cuspidi C, Meani S, Fusi V. et al . Metabolic syndrome and target organ damage in untreated essential hypertensives.  J Hypertens. 2004;  22 1991-1998
    CrossrefPubMedGoogle Scholar
  • 5 Declerck P J, Alessi M C, Verstreken M. et al . Measurement of plasminogen activator inhibitor-1 in biologic fluids with a murine monoclonal antibody-based enzyme-linked immunosorbent assay.  Blood. 1988;  71 220-225
    CrossrefPubMedGoogle Scholar
  • 6 Grundy S M, Brewer Jr B, Cleeman J I. et al . Definition of metabolic syndrome. Report of the National Heart, Lung and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition.  Circulation. 2004;  109 433-438
    CrossrefPubMedGoogle Scholar
  • 7 Devereux R B, Reicheck N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method.  Circulation. 1977;  55 613-618
    CrossrefPubMedGoogle Scholar
  • 8 Diamantopoulos E J, Andreadis E, Kakou M. et al . Atherosclerosis of carotid arteries and the ACE insertion/deletion polymorphism in subjects with diabetes mellitus type 2.  Int Angiol. 2002;  21 63-69
    PubMedGoogle Scholar
  • 9 Meigs J B, Nathan D M, D'Agostino R B, Wilson P WF. Fasting and post-challenge glycemia and cardiovascular risk: the Framigham offspring study.  Diabetes Care. 2002;  25 1845-1850
    CrossrefPubMedGoogle Scholar
  • 10 Ferrannini E, Vichi S, Nielsen H B. et al . Insulin action and age. European Group for the Study of Insulin Resistance (EGIR).  Diabetes. 1996;  45 947-953
    CrossrefPubMedGoogle Scholar
  • 11 Filiposky J, Svobodorova V, Pecen L. Reproducibility of radial pulse wave analysis in healthy subjects.  J Hypertension. 2000;  18 1033-1040
    PubMedGoogle Scholar
  • 12 Hanefeld M, Koehler C, Fuecker K. et al . Insulin secretion and insulin sensitivity pattern is different in isolated impaired glucose tolerance and impaired fasting glucose.  Diabetes Care. 2003;  26 868-874
    CrossrefPubMedGoogle Scholar
  • 13 Horio T, Miyazato J, Kamide K. et al . Influence of low high-density lipoprotein cholesterol on left ventricular hypertrophy and diastolic function in essential hypertension.  Am J Hypertens. 2003;  16 938-944
    CrossrefPubMedGoogle Scholar
  • 14 Lakka H M, Laaksonen D E, Lakka T A. et al . The metabolic syndrome and total and cardiovascular disease mortality in middled-aged men.  JAMA. 2002;  288 2709-2716
    CrossrefPubMedGoogle Scholar
  • 15 Lind L, Anderson P E, Andren B. et al . Left ventricular hypertrophy in hypertension is associated with insulin resistance metabolic syndrome.  J Hypertens. 1995;  13 433-438
    PubMedGoogle Scholar
  • 16 Matthews D R, Hosker J D, Rudenski A S. et al . Homeostasis model assessment: insulin resistance and β cell function from fasting plasma glucose and insulin concentration in man.  Diabetologia. 1989;  28 412-419
    PubMedGoogle Scholar
  • 17 Meigs J B, Ken Williams M S, Sullivan L M. et al . Using metabolic syndrome traits for efficient detection of impaired glucose tolerance.  Diabetes Care. 2004;  27 132-138
    PubMedGoogle Scholar
  • 18 Mullan B A, Young I S, Fee H. et al . Ascorbic acid reduces blood pressure and arterial stiffness in type 2 diabetes.  Hypertension. 2002;  40 804-809
    CrossrefPubMedGoogle Scholar
  • 19 Pedrinelli R, Dell' Omo G, Penno G. et al . Microalbuminuria, a parameter independent of metabolic influences in hypertensive men.  J Hypertens. 2003;  21 1163-1169
    PubMedGoogle Scholar
  • 20 Philips P I, Clark P M, Hales C N. et al . Understanding oral glucose tolerance test: comparison of glucose and insulin measurements during the OGTT with specific measurements of insulin resistance and secretion.  Diabet Med. 1994;  11 286-292
    CrossrefPubMedGoogle Scholar
  • 21 Rutter M K, Meigs J B, Sullivan L M. et al . C-reactive protein, the metabolic syndrome and prediction of cardiovascular events in the Framingham Offspring Study.  Circulation. 2004;  110 380-385
    CrossrefPubMedGoogle Scholar
  • 22 Sahn D J, De Maria A, Kisslo J. et al . Recommendations regarding quantification in M-Mode echocardiography: results of a survey of echocardiographic measurements.  Circulation. 1978;  58 1072-1083
    CrossrefPubMedGoogle Scholar
  • 23 Schram M T, Henry R M, vanDijk R A. et al . Increased central artery stifness in impaired glucose metabolism and type 2 diabetes. The Hoorn Study.  Hypertension. 2004;  43 176-181
    CrossrefPubMedGoogle Scholar
  • 24 SERA‐PAK immune Microalbumin. Publication No. TL9-6932K96. Bayer Corporation 1996
    Google Scholar
  • 25 Sowers J R, Frohlich E D. Insulin and insulin resistance: impact on blood pressure and cardiovascular disease.  Medical Clinics of North America. 2004;  88 63-82
    CrossrefPubMedGoogle Scholar
  • 26 Stern M P. Diabetes and cardiovascular disease. The “common soil” hypothesis.  Diabetes. 1995;  44 369-374
    PubMedGoogle Scholar
  • 27 The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus . Follow-up Report on the Diagnosis of Diabetes Mellitus.  Diabetes Care. 2003;  26 3160-3167
    CrossrefPubMedGoogle Scholar
  • 28 Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final report.  Circulation. 2002;  106 3143-3421
    PubMedGoogle Scholar
  • 29 Watanabe S, Okura T, Kitami Y. et al . Carotid hemodynamic alterations in hypertensive patients with insulin resistance.  Am J Hypertension. 2002;  15 851-856
    CrossrefPubMedGoogle Scholar
  • 30 World Health Organization .Definition, diagnosis and classification of diabetes mellitus and its complications: report of WHO consultation. Part 1: diagnosis and classification of diabetes mellitus.Available at: http://whqlibloc.who.int/hq/1999/WHO-NCD-NCS-992.pdf. Accessed December 12, 2003. Geneva, Switzerland; World Health Organization 1999
    Google Scholar
  • 31 Zimmet P, Alberti K G, Swaw J. Global and societal implications of the diabetes epidemic.  Nature. 2001;  414 782-787
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Emmanuel J. Diamantopoulos

10 Oitis Street

154 52 Paleo Psychiko

Athens

Greece

Phone: + 302107258862 or 2107201529

Fax: + 30 21 07 25 88 62

Email: Dpathologiki@evaggelismos-hosp.gr

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