The Metabolic Syndrome as Predictor of Type 2 Diabetes
The San Antonio Heart Study
Article Figures & Tables
Figures
- Figure 1—
Incident diabetes at the 7- to 8-year follow-up visit after stratification by age, sex, ethnicity, and BMI. A: Incident diabetes by age category (P for trend <0.0001). B: Age-adjusted incident diabetes by sex (P = 0.352) and ethnic group (P < 0.0001). C: Incident diabetes by BMI category (P for trend <0.0001). D: Incident diabetes by quartiles of fasting insulin (P for trend <0.0001).
- Figure 2—
Diabetes risk associated with IGT or the metabolic syndrome after stratification by baseline age or BMI. A: Diabetes risk by age categories in subjects with IGT (P for trend = 0.676), the NECP definition (P for trend = 0.650), or the modified WHO definition (P for trend = 0.076). B: Age- and sex-adjusted incident diabetes in subjects initially categorized by quartiles of BMI who had IGT (P for the trend = 0.002). C: Age- and sex-adjusted incident diabetes in participants initially categorized by quartiles of BMI that fulfill the NCEP definition (P for trend = 0.006). D: Age- and sex-adjusted incident diabetes by IGT and the NCEP definition.
- Figure 3—
ROC curves for the prediction of type 2 diabetes.
Tables
- Table 1—
Age- and sex-adjusted baseline characteristics by incident type 2 diabetes at follow-up
No diabetes Incident type 2 diabetes P n 1,539 195 — Age (years)* 42.7 ± 0.27 47.7 ± 0.77 <0.0001 Male (%)* 42.8 39.0 0.363 Mexican Americans (%)* 64.1 80.5 <0.0001 Family history of diabetes (%)* 30.3 45.6 <0.0001 BMI (kg/m2) 27.2 ± 0.13 31.3 ± 0.38 <0.0001 Waist circumference (cm) Men 94.2 ± 0.40 101.2 ± 1.18 <0.0001 Women 84.8 ± 0.46 96.4 ± 1.26 <0.0001 Fasting glucose (mmol/l) 4.70 ± 0.01 5.27 ± 0.04 <0.0001 2-h glucose (mmol/l) 5.58 ± 0.04 7.61 ± 0.12 <0.0001 HDL cholesterol (mmol/l) 1.24 ± 0.01 1.05 ± 0.02 <0.0001 Total cholesterol (mmol/l) 5.07 ± 0.02 5.06 ± 0.07 0.828 Triglycerides (mmol/l) 1.50 ± 0.03 2.19 ± 0.08 <0.0001 SBP (mmHg) 117.5 ± 0.35 123.6 ± 0.98 <0.0001 DBP (mmHg) 71.5 ± 0.22 74.8 ± 0.64 <0.0001 Fasting insulin (μU/ml) 12.2 ± 0.35 22.3 ± 0.98 <0.0001 IGT (%) 7.4 44.9 <0.0001 IFG (%) 1.0 7.4 <0.0001 NCEP definition (%) 14.4 48.7 <0.0001 Modified WHO definition (%) 12.5 41.3 <0.0001 -
Data are means ± SE.
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↵* Not adjusted for age and sex. DBP, diastolic blood pressure; SBP, systolic blood pressure.
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- Table 2—
Sensitivity, specificity, and predicted values of IGT and the metabolic syndrome for identifying subjects at risk for type 2 diabetes
Sensitivity Specificity Positive predictive value Negative predictive value IGT (2-h glucose ≥7.8 mmol/l in nondiabetic subjects) 51.9 91.5 43.0 93.9 IFG (fasting glucose ≥6.1 mmol/l in nondiabetic subjects) 9.2 98.9 51.4 89.6 NCEP definition 52.8 84.9 30.8 93.4 Modified WHO definition 42.8 87.2 30.4 92.1 NCEP definition and/or IGT 70.8 79.1 29.7 95.6 Modified WHO definition and/or IGT 66.3 80.9 30.7 94.9 Fasting plasma glucose requirement changed to ≥5.4 mmol/l Fasting glucose ≥5.4 mmol/l 42.6 91.7 39.3 92.6 NCEP definition with fasting glucose ≥5.4 mmol/l* 62.0 82.4 30.9 94.5 Modified WHO definition with fasting glucose ≥5.4 mmol/l† 49.5 85.4 30.6 92.9 NCEP definition and/or a fasting glucose ≥5.4 mmol/l 69.7 79.0 29.7 95.3 Modified WHO definition and/or a fasting glucose ≥5.4 mmol/l 60.3 81.1 29.3 94.0 -
↵* The NCEP definition with fasting glucose ≥5.4 mmol/l required at least three of the following: increased waist circumference (>102 cm in men and >88 cm in women), high triglycerides (≥1.7 mmol/l), low HDL cholesterol (<1.04 mmol/l in men and <1.29 mmol/l in women), high blood pressure (≥130/85 mmHg or treated for hypertension), and fasting plasma glucose (≥5.4 mmol/l);
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↵† modified WHO definition with fasting glucose ≥5.4 mmol/l required fasting plasma glucose ≥5.4 mmol/l or hyperinsulinemia (fasting insulin in the top quartile of the nondiabetic population) plus at least two of the following: obesity (BMI ≥30 kg/m2 or waist-to-hip ratio >0.9 in men and >0.85 in women), dyslipidemia (HDL cholesterol <0.9 mmol/l in men and <1.0 mmol/l in women or triglycerides ≥1.7 mmol/l), and hypertension (≥140/90 mmHg or treated for hypertension).
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- Table 3—
Multiple logistic regression analysis of incident diabetes with age, sex, family history of diabetes, NCEP definition, IGT, and fasting insulin as independent covariates
OR 95% CI OR 95% CI OR 95% CI OR 95% CI NCEP definition (yes vs. no) 6.30 4.60–8.63 5.54 4.01–7.66 3.77 2.63–5.39 3.30 2.27–4.80 Age (× 10-year interval) — — 1.39 1.20–1.62 1.25 1.06–1.48 1.28 1.08–1.51 Sex (men vs. women) — — 0.87 0.62–1.20 0.99 0.69–1.42 0.93 0.64–1.33 Mexican American vs. non-Hispanic white — — 1.98 1.33–2.94 1.66 1.08–2.55 1.65 1.07–2.57 Family history of diabetes (yes vs. no) — — 1.68 1.21–2.34 1.74 1.21–2.49 1.77 1.23–2.54 IGT (yes vs. no) — — — — 7.00 4.84–10.1 6.37 4.37–9.28 Fasting insulin (× 10-μU/ml interval) — — — — — — 1.37 1.19–1.58
