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The Metabolic Syndrome Is a Risk Indicator of Microvascular and Macrovascular Complications in Diabetes

Results from Metascreen, a multicenter diabetes clinic–based survey

Address correspondence and reprint requests to Bonadonna Riccardo, MD, Division of Endocrinology and Metabolic Diseases, Ospedale Civile Maggiore, Piazzale Stefani 1, 137126 Verona, Italy. E-mail: riccardobonadonna{at}tiscali.it

OBJECTIVE—We aimed at assessing the degree of association and the predictive power of the metabolic syndrome with regard to clinically detectable complications in patients with diabetes.

RESEARCH DESIGN AND METHODS—Metascreen is a cross-sectional survey of metabolic syndrome and clinically detected diabetes complications performed in 8,497 patients (7,859 with type 2 diabetes and 638 with type 1 diabetes) randomly chosen in 176 diabetes outpatient clinics throughout Italy. The metabolic syndrome was defined according to either the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) or the International Diabetes Federation (IDF) diagnostic criteria. Multivariate analyses of the association(s) between either AHA/NHLBI or IDF metabolic syndrome and clinical complications were performed. Receiver-operator characteristic (ROC) curves were constructed to compare the predictive power of the two sets of diagnostic criteria of the metabolic syndrome.

RESULTS—Either definition of the metabolic syndrome was an independent statistical indicator of the presence of nephropathy and neuropathy (P < 0.02–0.01) in type 1 diabetes and of all complications (P < 0.0001), including cardiovascular disease and retinopathy, in type 2 diabetes. For each complication, the ROC curves based on either AHA/NHLBI or IDF metabolic syndrome were similar to each other and to the ROC curves constructed with all continuous traits compounding the metabolic syndrome.

CONCLUSIONS—The metabolic syndrome, defined according to AHA/NHLBI or IDF diagnostic criteria, is an independent clinical indicator and may be involved in the pathogenesis of both macro- and microvascular complications of diabetes.

Abbreviations: AHA, American Heart Association • IDF, International Diabetes Federation • NCEP, National Cholesterol Education Program • NHLBI, National Heart, Lung, and Blood Institute • ROC, receiver-operator characteristic

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