The Metabolic Syndrome and Incident Diabetes: Current State of the Evidence

Abstract

Objective Our objective was to perform a quantitative review of prospective studies examining the association between the metabolic syndrome and incident diabetes.

Research Design and Methods Using the title terms “diabetes” and “metabolic syndrome” in PUBMED, we searched for articles published since 1998.

Results Based on the results from 16 cohorts, we performed a meta-analysis of estimates of relative risk and incident diabetes. The random-effects summary relative risks were 5.17 (95% confidence interval [CI]: 3.99-6.69) for the 1999 World Health Organization definition (ten cohorts), 4.45 (95% CI: 2.41-8.22) for the 1999 European Group for the Study of Insulin Resistance definition (four cohorts), 3.53 (95% CI: 2.84-4.39) for the 2001 National Cholesterol Education Program definition (thirteen cohorts), 5.12 (95% CI: 3.26-8.05) for the 2005 American Heart Association/National Heart, Lung, and Blood Institute definition (five cohorts), and 4.42 (95% CI: 3.30-5.92) for the 2005 International Diabetes Federation definition (nine cohorts). The fixed-effects summary relative risk for the 2004 National Heart, Lung, and Blood Institute/American Heart Association definition was 5.16 (95% CI: 4.43-6.00) (six cohorts). The number of components was strongly related to incident diabetes. Compared with participants without an abnormality, estimates for those with 4 or more abnormal components ranged from 10.88 to 24.4. Limited evidence suggests fasting glucose alone may be as good as metabolic syndrome for diabetes prediction.

Conclusions The metabolic syndrome, however defined, is associated more strongly with incident diabetes than previously demonstrated for coronary heart disease. Its clinical value for diabetes prediction remains uncertain.