American College of Endocrinology Pre-Diabetes Consensus Conference: Part Three
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York
The American College of Endocrinology held a Consensus Conference in Washington, DC, on 21–22 July 2008 on the topic of pre-diabetes, organized around a series of interrelated questions. This is the third of a three-part series summarizing presentations at the conference.
What are the appropriate measures to monitor pre-diabetes and its treatment?
Peter Wilson (Boston, MA) reviewed Framingham data, with 30-year follow-up now available, showing greater evidence of adverse cardiovascular disease (CVD) outcome with diabetes. It has been recognized for some time that there are clustered abnormalities within the metabolic syndrome spectrum. BMI, triglycerides, waist circumference, HDL cholesterol, and fasting and 2-h insulin form one group; fasting and 2-h insulin and glucose another; and BMI and diastolic and systolic blood pressure levels a third (1), with hyperinsulinemia a crucial factor in many of these associations (2). Homeostasis model assessment of insulin resistance is associated with left ventricular mass in women, though not in men (3). Meigs and colleagues (4) showed evidence that the coronary artery calcium score is associated with insulin resistance and with pre-diabetes. Metabolic syndrome is certainly related to outcome, with CVD two to three times and diabetes seven times more likely in those with 3–5 vs. 0–2 components of the syndrome. In this analysis, the population-attributable risk of metabolic syndrome is approximately one-third that of CVD and two-thirds that of diabetes for men, with glucose (as expected) the major determinant of diabetes risk among metabolic syndrome variables. Population-attributable risks of metabolic syndrome were somewhat lower for women. An alternative analysis divides metabolic syndrome factors into none vs. 1–2 vs. 3–5, with a suggestion of increased risk even in the intermediate group and of markedly increased risk in comparison with 3–5 vs. no metabolic syndrome factors. If a measure of insulin resistance is added to metabolic syndrome, both diabetes and CVD risks are markedly augmented (5). There are arguments …
